FOUR FACTORS OF IMPULSIVITY DIFFERENTIATE ANTISOCIAL AND BORDERLINE PERSONALITY DISORDERS

Transcription

1 Journal of Personality Disorders, 27(2), , The Guilford Press FOUR FACTORS OF IMPULSIVITY DIFFERENTIATE ANTISOCIAL AND BORDERLINE PERSONALITY DISORDERS Hilary L. DeShong, MS, and John E. Kurtz, PhD Impulsivity is a shared criterion for the diagnosis of antisocial and borderline personality disorders, and this link may account for the high comorbidity rates between the two disorders. The current study aimed to differentiate between borderline and antisocial personality disorders using the four factors of impulsivity identified by Whiteside and Lynam (2001). Five hundred thirty-six undergraduate participants completed the Personality Assessment Inventory (PAI; Morey, 1991) to assess borderline and antisocial personality features and the NEO Personality Inventory, Third Edition (NEO-PI-3; McCrae & Costa, 2010) to assess the four factors of impulsivity. Results indicate that negative urgency and lack of perseverance were significantly and uniquely related to borderline features, while sensation seeking and lack of premeditation were significantly and uniquely related to antisocial features. The implications of these results for improved differential diagnosis are discussed. Comorbidity in the personality disorder domain is a common problem that complicates differential diagnosis, especially between antisocial personality disorder (APD) and borderline personality disorder (BPD). Prevalence studies continue to demonstrate that these two disorders are highly comorbid (Becker, Grilo, Edell, & McGlashan, 2000; Grant et al., 2008; Zanarini et al., 1998; Zimmerman, Rothschild, & Chelminski, 2005). Several researchers have proposed that the shared criterion of impulsivity accounts for the high comorbidity rate between BPD and APD (Beauchaine, Klein, Crowell, Derbidge, & Gatzke-Kopp, 2009; Lofgren, Bemporad, King, & Lindem, 1991; Paris, 1997). According to the DSM-IV-TR, the word impulsivity is employed in both criteria sets, although for BPD it is elaborated with a specific list of impulsive behaviors (American Psychiat- This article was accepted under the editorship of Robert F. Krueger and John Livesley. From Oklahoma State University (H. L. D.) and Villanova University (J. E. K.). The authors acknowledge Katie Sanders, Nicole Cross, Lindsey Bupp, Mary-Kate Duffy, and Kelly McCusker on their assistance. We appreciate all the time and effort that each put into this project. Address correspondence to Hilary L. DeShong, 116 N. Murray Hall, Department of Psychology, Oklahoma State University, Stillwater, OK ; hilary.deshong@okstate. edu 144

2 IMPULSIVITY DIFFERENTIATES PDS 145 ric Association, 2000). A closer look at the underlying nature of the impulsivity construct could help differentiate the two disorders conceptually and facilitate their differential diagnosis. Impulsivity has been given many different definitions by theorists, including excitement or novelty seeking, the inability to plan ahead, lack of self-control, venturesomeness, psychoticism as defined by Eysenck and Eysenck (1975), and the tendency to act rashly (Barratt, 1993; Buss & Plomin, 1975; Cloninger, Przybeck, & Svrakic, 1991; Costa & McCrae, 1992a; Eysenck & Eysenck, 1975; Tellegen, 1982, 1985; Zuckerman, Kuhlman, Joireman, Teta, & Kraft, 1993). Each of these theories has had difficulty with placing impulsivity firmly in a specific place within their respective models. For example, Eysenck and Eysenck (1975) placed impulsivity under the Psychoticism domain, but they found that it also correlated with the other two domains of the model (i.e., extraversion and neuroticism). Zuckerman and colleagues (1993) focused on the sensation seeking aspect of impulsivity within their model. Buss and Plomin (1975) debated where to put impulsivity within their model, even removing it and then putting it back in, before finally giving it a broad definition with a number of aspects, including inhibitory control, decision time, sensation seeking, and lack of persistence. Clearly, there has been a long history of confusion with regard to the definition of this construct. More recently, the varieties of impulsivity have been investigated with reference to the Five-Factor Model (FFM) of personality, which is a useful taxonomy for understanding complex and multifaceted constructs. Using this comprehensive scheme of personality traits, Whiteside and Lynam (2001) had a group of 437 undergraduates complete the Revised NEO Personality Inventory (NEO-PI-R; Costa & McCrae, 1992a), eight other questionnaire measures of impulsivity previously used in the literature, and 14 additional impulsiveness items created by the investigators. Using exploratory factor analysis, four distinct factors were extracted from this wide array of impulsivity scales and items. Whiteside and Lynam (2001) proposed that this four-factor model presents a new perspective which regards impulsivity as an artificial umbrella term that actually encompasses four distinct facets of personality associated with impulsive behavior (p. 687). Whiteside and Lynam (2001) named this structure the UPPS model, after the labels for each of the four factors: urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking. Urgency is the tendency to commit rash or regrettable actions as a result of intense negative affect and includes behaviors such as an inability to resist cravings, bingeing, and acting carelessly while upset. Sensation seeking is the tendency to pursue excitement and includes behaviors such as using drugs and stealing. Premeditation is the tendency to delay action in favor of careful thinking and planning. Someone with a lack of premeditation displays impulsivity by acting hastily without thinking, such as cheating on a test without considering the consequences of being caught. Perseverance is the ability to remain with a task until completion. A person with a lack of persever-

3 146 DESHONG AND KURTZ ance displays impulsivity through behaviors such as being unable to finish papers and projects. The factor analysis of Whiteside and Lynam (2001) also identified four facet scales of the NEO-PI-R that serve as strong markers of each factor of impulsivity. Urgency can be measured using the Impulsiveness scale of the NEO-PI-R, which is a facet in the Neuroticism domain. This scale assesses the tendency to give in to cravings and urges. Sensation seeking can be measured using the Excitement Seeking scale, which is a facet in the Extraversion domain. This scale assesses the tendency to take risks and seek out stimulating activities. Premeditation can be measured using the Deliberation scale, which is a facet in the Conscientiousness domain. This scale assesses the tendency to think through the potential consequences of behaviors before acting. Lastly, perseverance can be measured using the Self-Discipline scale, which is also a facet in the Conscientiousness domain. This scale assesses the ability to complete tasks or obligations despite boredom, fatigue, or distraction. Whiteside and Lynam (2001) propose that these distinct factors of impulsivity give rise to a great variety of behaviors we call impulsive, and these behaviors may be assigned to different categories of psychopathology. Therefore, assessing and understanding these different types of impulsivity may facilitate discriminations between commonly overlapping disorders, such as APD and BPD. Furthermore, the NEO-PI-R appears to provide reliable and valid scales for assessment of the four factors. To date, three empirical studies have been conducted on the relationship between the UPPS model (Whiteside & Lynam, 2001) and APD and/ or BPD. Miller, Flory, Lynam, and Leukefeld (2003) tested the relationship of the four impulsivity factors, as measured by the NEO-PI-R, to various forms of externalizing and internalizing psychopathology in a sample of 481 young adults aged 20 to 21 years. Based on previous theory and research, Miller et al. hypothesized that urgency would be correlated with BPD and lack of premeditation would be correlated with APD. The Diagnostic Interview Schedule (DIS; Robins, Cottler, Bucholz, & Compton, 1997) and the Levenson Self-Report Psychopathy Scale (LSRP; Levenson, Kiehl, & Fitzpatrick, 1995; Lynam, Whiteside, & Jones, 1999) were used to assess APD, and BPD was measured using a selection of relevant items from the Brief Symptom Inventory (BSI; Derogatis, 1993). Symptoms of APD as assessed by the DIS correlated highest with (Lack of) Premeditation followed by Sensation Seeking. APD as assessed by the LSRP also correlated highest with (Lack of) Premeditation, followed by (Lack of) Perseverance. The BPD scale created for this study was significantly correlated with Urgency, but only in females; the second highest correlate was (Lack of) Perseverance. Thus, the Miller et al. study supported the hypothesis that APD is specifically associated with lack of premeditation, but support for the hypothesis linking BPD and urgency was mixed. Nonetheless, the study demonstrated promise that the four factors of impulsivity may be useful for differentiating BPD and APD.

4 IMPULSIVITY DIFFERENTIATES PDS 147 Whiteside, Lynam, Miller, and Reynolds (2005) investigated links between impulsivity with BPD and APD using the UPPS Impulsive Behavior Scale, which was introduced in the original study by Whiteside and Lynam (2001). A diverse group of 92 clinical participants were recruited from outpatient treatment organizations, community mental health centers, and support groups, and a control group of 29 adults were recruited from waiting areas in hospital medical clinics. All of the participants completed the Borderline Features (BOR) scale and an abbreviated version of the Antisocial Features (ANT) scale from the Personality Assessment Inventory (PAI; Morey, 1991), as well as the UPPS scale. Multiple regression analyses indicated that the UPPS scales collectively accounted for a significant portion of variance in BOR and ANT scores. Urgency was significantly related to both disorders, but, congruent with the hypothesis of Miller et al. (2003), it showed a stronger relationship with BOR than with ANT. Sensation Seeking showed significant and comparable correlations with both PAI scales. (Lack of) Premeditation was significantly correlated with ANT but not with BOR, whereas (Lack of) Perseverance was significantly correlated with BOR but not with ANT. These findings demonstrate further that the two personality disorders may have distinctive relationships with the four factors of impulsivity. Tragesser and Robinson (2009) looked at the relationship between the UPPS scales and borderline features in 141 undergraduates. Participants completed the Borderline Features (BOR) scale of the PAI (Morey, 1991) and the UPPS impulsivity scale (Whiteside & Lynam, 2001). The authors performed a path analysis linking the four UPPS scores with a latent BPD variable that was composed of the four subscales of the BOR scale from the PAI. Significant path coefficients were observed between (Lack of) Premeditation and Urgency scores and the latent BPD variable. The path coefficients between BOR and Stimulus Seeking and (Lack of) Perseverance were not significant. Regression analyses further demonstrated that the links between BOR scores and both Urgency and (Lack of) Premeditation remained significant after controlling for measures of affective instability. Taken collectively, these three studies show some consistent findings, but there are also some conflicting results that need to be addressed. The hypotheses of Miller et al. (2003) were supported in that significant links between urgency and BPD were observed in all three studies and lack of premeditation was associated with APD in the two studies that tested this link. There was an association between lack of perseverance and BPD in two of the three studies that was not hypothesized. Finally, sensation seeking did not show consistent relationships with either BPD or APD across studies. Each of the three studies has some weakness in measurement of the personality disorders that will be addressed in the current study. Miller et al. (2003) used the BSI to assess borderline traits, but the BSI is not a validated measure of BPD. Whiteside et al. (2005) used only 18 of the 24 items from the PAI that are included in the total ANT score. Tragesser and Robinson (2009) assessed only BPD, so it remains unclear

5 148 DESHONG AND KURTZ what effect the shared variance between BOR and ANT would have on the path coefficients they obtained. The current study will address these limits by having a large sample of college students complete both the ANT and BOR scales of the PAI in order to assess whether the four factors of impulsivity can differentiate between BPD and APD. Specifically, the current study will test the following four hypotheses derived from theory and existing data: 1. Urgency will be significantly correlated with BPD and will be relatively less correlated with APD. This hypothesis was proposed by Miller et al. (2003) and is consistent with the findings of the three previous studies just described. It also fits with the DSM concept of the self-damaging nature of impulsivity in BPD (e.g., American Psychiatric Association, 2000). 2. Lack of perseverance will be significantly correlated with BPD and will be relatively less correlated with APD. This hypothesis has not been tendered previously, but it fits with the DSM-IV concept of instability in goals and behaviors and proneness to boredom in BPD (American Psychiatric Association, 2000). It has also received some empirical support in two previous studies (Miller et al., 2003; Whiteside et al., 2005). 3. Lack of premeditation will be significantly correlated with APD and will be relatively less correlated with BPD. The DSM-IV further qualifies the impulsivity of APD as failure to plan ahead and consider the consequences of decisions. This hypothesis was also proposed by Miller et al. (2003) and has received empirical support in the Miller et al. and Whiteside et al. (2005) studies. 4. Sensation seeking will be significantly correlated with APD and will be relatively less correlated with BPD. This hypothesis has not been tendered previously, but it is congruent with the DSM-IV description of reckless disregard for self and others in APD, leading to behaviors with high risk for harmful consequences (American Psychiatric Association, 2000). METHOD PARTICIPANTS Participants were recruited using the psychology human subjects pool at a medium-sized, Eastern, private university. Five hundred sixty-seven students took part in the study protocol, but 536 cases were used for statistical analyses due to exclusionary criteria described below. The mean age of participants was 18.9 years, with all participants between the ages of 17 and 26, and 318 (59.3%) were female. Eighty-one percent of participants classified their ethnicity as White, 4% as African American, 4% as Latino, 7% as Asian, and 4% as other or mixed ethnicity. Sixty-one per-

6 IMPULSIVITY DIFFERENTIATES PDS 149 cent of the participants were freshmen, 29% were sophomores, 7% were juniors, and 3% were seniors. MEASURES Personality Assessment Inventory (PAI). Individuals completed the PAI (Morey, 1991), a self-report inventory that measures normal and abnormal personality traits and clinical constructs. The 344 items use a fourpoint response format with options labeled False, not at all true, Slightly true, Mainly true, or Very true. The PAI contains 22 nonoverlapping scales, including four validity scales, 11 clinical scales, two interpersonal scales, and five treatment-relevant scales. The current study focused on the two scales that measure borderline (BOR) and antisocial (ANT) features; both scales contain 24 items. Additionally, BOR is further broken down into four six-item subscales and ANT is further broken down into three eight-item subscales. These will not be considered for this specific study, because it is looking only at the total scale scores of the BOR and the ANT scales. The BOR scale has been found to have good reliability and validity in both college populations (Kurtz, Morey, & Tomarken, 1993; Trull, 1995, 1997) and clinical populations (Jacobo, Blais, Baity, & Harley, 2007; Kurtz & Morey, 2001). The ANT scale has been found to have good reliability and validity in both college populations (Hicklin & Widiger, 2005; Kurtz et al., 1993; Salekin, Trobst, & Krioukova, 2001) and clinical populations (Crocker et al., 2005; Diamond & Magaletta, 2006). NEO Personality Inventory-3 (NEO-PI-3). Participants also completed the NEO-PI-3 (McCrae & Costa, 2010), a 240-item self-report inventory that assesses basic personality traits based on the FFM. The NEO-PI-3 is a recent revision that incorporates item changes and new reference samples, but it follows the scale structure of the NEO-PI-R (Costa & McCrae, 1992a) originally proposed by Whiteside and Lynam (2001) to assess the four factors of impulsivity. It has been shown by De Fruyt, De Bolle, McCrae, Terracciano, and Costa (2009) to be a more readable version of the NEO Personality Inventory, with stronger item-total correlations and improved facet reliabilities. Therefore, the theories and hypotheses derived from the NEO-PI-R are transferrable to the NEO-PI-3. The four factors of impulsivity (Urgency, Sensation Seeking, Perseverance, and Premeditation) are measured by the N5 Impulsiveness, E5 Excitement Seeking, C5 Self- Discipline, and C6 Deliberation subscales, respectively, of the NEO-PI-3. The original keying direction was retained here for Perseverance and Premeditation, such that lower scores are indicative of greater impulsivity and negative correlations with BPD and APD are predicted by the hypotheses. Although validity research using this new version was pending at the time of the study, the test manual (McCrae & Costa, 2010) documents extensive research that demonstrates good reliability and validity of the NEO inventories as measures of the FFM (see also Costa & McCrae, 1992b, 1992c, 1995; Markon, Krueger, & Watson, 2005; McCrae, Kurtz, Yamagata, & Terracciano, 2011).

7 150 DESHONG AND KURTZ PROCEDURE Participants signed up online and completed the study protocol in our laboratory during a single 90-minute session supervised by a graduate or undergraduate research team member. All participants were asked to read and sign a statement of informed consent. Participation was voluntary and anonymous, and all students were assured that their responses and data would be kept confidential. Participants completed both the NEO- PI-3 and the PAI, and the order of administration was counterbalanced by gender; 265 individuals (males = 104, females = 161) completed the NEO- PI-3 first and the PAI second and 271 individuals (males = 114, females = 157) completed the PAI first and the NEO-PI-3 second. After completing the two questionnaires, participants were given a debriefing form that explained the goals and aims of the study. For completing the study, all participants were given course credit toward requirements of an introductory psychology course. RESULTS A total of 567 undergraduates participated in the study. Cases were classified as invalid if T-scores exceeded 70 on the PAI Inconsistency (ICN) scale and/or the PAI Infrequency (INF) scale. 1 Fourteen cases were elevated on ICN, and 22 cases were elevated on INF. Cases were considered to have excessive missing responses if 33 or more of the PAI items were left blank or 24 or more of the NEO-PI-3 items were left blank (McCrae & Costa, 2010; Morey, 1991). Two cases had excess missing data on the PAI, and one case had excess missing data on the NEO-PI-3. Thirty-one cases met one or more of these exclusion criteria, leaving 536 cases for the statistical analyses. The descriptive statistics of the two PAI scales and the four NEO-PI-3 scales are given by gender in Table 1. The only significant TABLE 1. Descriptive Statistics for PAI and NEO-PI-3 Scales by Gender Male Mean (SD) Female Mean (SD) PAI Scales Borderline Features (10.42) (10.33) Antisocial Features (11.11) (11.12) NEO-PI-3 Scales N5 Impulsivity (Urgency) (10.38) (11.28) E5 Excitement (Sensation Seeking) (8.51) (8.72) C5 Self-Discipline (Perseverance) (12.13) (12.00) C6 Deliberation (Premeditation) (10.46) (11.95) Note. Male n = 218; Female n = 318; PAI scores are given as T-scores based on normative sample of 1,000 community adults (see Morey, 1991); NEO- PI-3 scores are given as T-scores based on normative sample of 635 community adults (see McCrae & Costa, 2010). 1. These cut scores for excluding protocols on the basis of random or careless responding are slightly more conservative than the cut scores suggested for INF (T = 75) and ICN (T = 73) in the PAI test manual (Morey, 1991).

8 IMPULSIVITY DIFFERENTIATES PDS 151 difference by gender is observed for ANT scores from the PAI (t = 5.08; p <.001; Cohen s d =.47), where males obtain higher average scores than females. The BOR and ANT scales are moderately correlated in this sample (r =.41), indicating that the two scales have a high level of overlap but that they are measuring some different aspects of personality and psychopathology. The intercorrelations of the four impulsivity scores from the NEO-PI-3 were very similar to those reported by Miller et al. (2003) with the NEO-PI-R. The highest correlation was observed between Urgency (N5 Impulsivity) and Premeditation (C6 Deliberation) (r =.55), and the lowest was between Sensation Seeking (E5 Excitement Seeking) and Perseverance (C5 Self-Discipline) (r =.00). The study hypotheses were tested with two hierarchical multiple regression analyses. The first regression model employed PAI BOR scores as the criterion variable. In the first step, a dummy coded gender variable (1 = female; 2 = male) was entered as a control variable. In the second step, Urgency (N5 Impulsivity), Sensation Seeking (E5 Excitement Seeking), Premeditation (C6 Deliberation), and Perseverance (C5 Self-Discipline) scores from the NEO-PI-3 were entered simultaneously. The regression coefficients extracted from the full model were significant for Urgency (N5 Impulsivity) and Perseverance (C5 Self-Discipline), but they were not significant for Sensation Seeking (E5 Excitement Seeking) and Premeditation (C6 Deliberation) (see Table 2). The second regression model employed PAI ANT scores as the criterion variable. Again, gender was entered in a first step, and all four NEO-PI-3 scores were entered simultaneously in a second step. The regression coefficients extracted from the full model were significant for Premeditation (C6 Deliberation), Sensation Seeking (E5 Excitement Seeking), and Urgency (N5 Impulsivity), but they were not significant for Perseverance (C5 Self-Discipline) (see Table 2). Confidence intervals (95%) were computed for the semipartial correlations extracted from both models, and these are also reported in Table 2. These confidence intervals can be used to test for differences in the unique correlations between each NEO-PI-3 impulsivity score with BOR versus ANT. These comparisons demonstrate that Urgency (N5 Impulsivity) correlates higher with BOR than with ANT, supporting Hypothesis 1, and Perseverance (C5 Self-Discipline) shows a higher negative correlation with BOR TABLE 2. Correlations Between NEO-PI-3 Impulsivity Scales and PAI Borderline (BOR) and Antisocial (ANT) Features Scales BOR ANT r sr 95% CI r sr 95% CI Urgency (N5).56*.37*.30 to.44.39*.11*.02 to.19 Perseverance (C5).44*.21*.29 to to.05 Premeditation (C6).36* to.07.56*.29*.37 to.21 Sensation Seeking (E5) to.01.40*.21*.13 to.29 Total R Note. *p <.01; N = 536; r = zero-order correlations; sr = semipartial correlations controlling for gender and remaining three NEO-PI-3 scores; Total R = multiple correlation of all four NEO-PI-3 scores with PAI score.

9 152 DESHONG AND KURTZ than with ANT, supporting Hypothesis 2. Furthermore, Premeditation (C6 Deliberation) shows a higher negative correlation with ANT than with BOR, supporting Hypothesis 3, and Sensation Seeking (E5 Excitement Seeking) correlates higher with ANT than with BOR, supporting Hypothesis 4. The foregoing regression analyses provide full support for the hypotheses tendered, but they are limited in one important respect. Specifically, only one of the two personality disorders is tested in each analysis; thus the BOR and ANT scores are treated as independent criteria in the two separate analyses when in fact there is a moderate correlation between them. Therefore, all four hypotheses were evaluated simultaneously using maximum likelihood estimation of the path analytic model depicted in Figure 1. In this model, the four impulsivity scores are treated as exogenous variables and the BOR and ANT scores are treated as endogenous variables. The four impulsivity traits are causal variables in this model in that they are considered to be manifestations of basic tendencies, whereas the personality disorder concepts are considered to be characteristic adaptations that are the outcome of basic tendencies and life experiences (cf. McCrae & Costa, 1996). The four nonhypothesized links were set to zero, and the four hypothesized links were free parameters to be estimated. Using the Amos program (Arbuckle, 2006), the path model in Figure 1 yielded reasonable fit coefficients, χ 2 (4) = 13.17, p =.01; comparative fit index =.99; root mean square error of approximation =.065, with 90% confidence FIGURE 1. Path model testing hypothesized relationships between NEO-PI-3 impulsivity scales and PAI personality disorder scales.

10 IMPULSIVITY DIFFERENTIATES PDS 153 interval =.028 to.106. The estimated path coefficients show medium effect sizes for the links predicted by Hypotheses 1 and 3, and small effect sizes for the links predicted by Hypotheses 2 and 4. DISCUSSION Comorbidity between the personality disorders continues to be an issue that complicates the accurate diagnosis of important conditions like BPD and APD. The current study proposed that borderline and antisocial personality disorders could be discriminated using the four factors of impulsivity identified by Whiteside and Lynam (2001). This question was addressed by having a large sample of undergraduates complete the NEO-PI-3 and the PAI. The PAI assesses features of the antisocial and borderline personality disorders, and the NEO-PI-3 includes four subscales that assess the four types of impulsivity. To summarize, the four factors of impulsivity measured by the NEO-PI-3 are significantly related to BOR or ANT scores from the PAI in a pattern that fits with theory and existing data. The hypothesized links originally proposed by Miller et al. (2003) for BPD and APD showed larger effects than the other two new links proposed for the current study. That is, negative urgency (N5 Impulsivity) is the primary aspect of impulsivity seen in BPD, with lack of perseverance (C5 Self-Discipline) also playing a role; these two aspects of impulsivity were largely unrelated to APD. Lack of premeditation (C6 Deliberation) is the primary aspect of impulsivity seen in APD, with sensation seeking (E5 Excitement Seeking) also playing a role, and these two aspects were largely unrelated to BPD. Overall, these findings support the utility of Whiteside and Lynam s (2001) multidimensional model of impulsivity as well as the views of theorists that impulsivity represents a compound trait (Depue & Collins, 1999). Although the results of the current study are largely in line with three previous studies of these links, the current findings are somewhat more clean in that each of the four impulsivity factors links with one of the two personality disorders. The current results are fully consistent with the simultaneous regression results from the Miller et al. (2003) study, lending corroboration to their unpredicted associations between BPD and lack of perseverance (C5 Self-Discipline) and between APD and sensation seeking (E5 Excitement Seeking). The findings of Whiteside et al. (2005) were inconsistent with the current study in that sensation seeking was related to both BPD and APD. This is perhaps related to their decision to drop the items from the Stimulus Seeking subscale of ANT from their version of the PAI measure. Tragesser and Robinson (2009) examined only BPD features, finding them to be significantly related to lack of premeditation, rather than to lack of perseverance, in addition to urgency. This disparate result may have occurred because APD features were not assessed simultaneously, which prevented Tragesser and Robinson from controlling for the shared variance between BPD and APD in their correlational analyses.

11 154 DESHONG AND KURTZ Overall, the results of these studies demonstrate the construct validity of the four-factor model of impulsivity and the promise it holds for discriminating categories of psychopathology that share the broad symptom of impulsive behavior. More specifically, these findings suggest that improved differential diagnosis of BPD and APD could be accomplished by a more finely tuned specification of the impulsivity criterion that is common to both disorders. The use of an undergraduate student sample is a limitation of the current study that must be considered. The findings here may not generalize to the adult population, because these college students are younger, less ethnically diverse, and of higher socioeconomic status. Also, these findings may not generalize to clinical populations, so the validity of the four factors for assessment of patients must be accepted cautiously. Testing these hypotheses with clinical samples is needed, especially with individuals who meet formal diagnostic criteria for borderline and antisocial personality disorders. Of course, diagnostic efficiency will vary by the specific impulsivity measure used. The UPPS scales of Whiteside and Lynam (2001) may produce stronger findings than the NEO scales, because they were devised specifically to assess the four factors of impulsivity. Moreover, the UPPS model has been adjusted to include a positive urgency factor (i.e., UPPS-P model; Cyders et al., 2007). Testing this updated model could produce different findings that help to further differentiate the personality disorders. Finally, it may be informative to study the four factors from a developmental perspective to see how these variants of impulsivity are expressed in childhood and adolescence. Understanding the developmental pathways of impulsive traits to subsequent behavior problems could provide better understanding of certain Axis I disorders, such as eating disorders and substance use disorders, because these disorders often have an impulsive component. Further evidence of how the four types of impulsivity map onto these disorders may also offer insights for designing more effective treatment strategies. REFERENCES American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Arbuckle, J. L. (2006). Amos (Version 7.0) [Computer program]. Chicago, IL: SPSS. Barratt, E. S. (1993). Impulsivity: Integrating cognitive, behavioral, biological and environmental data. In W. Mc- Cowan, J. Johnson, & M. Shure (Eds.), The impulsive client: Theory, research, and treatment. (pp ). Washington, DC: American Psychological Association. Beauchaine, T. P., Klein, D. N., Crowell, S. E., Derbidge, C., & Gatzke-Kopp, L. (2009). Multifinality in the development of personality disorders: A biology sex environment interaction model of antisocial and borderline traits. Development and Psychopathology, 21, Becker, D. F., Grilo, C. M., Edell, W. S., & McGlashan, T. H. (2000). Comorbidity of borderline personality disorder with other personality disorders in hospitalized adolescents and adults. American Journal of Psychiatry, 157,

12 IMPULSIVITY DIFFERENTIATES PDS 155 Buss, A. H., & Plomin, R. (1975). A temperament theory of personality development. New York: John Wiley & Sons. Cloninger, C. R., Przybeck, T. R., & Svrakic, D. M. (1991). The Tridimensional Personality Questionnaire: US normative data. Psychological Reports, 69, Costa, P. J., Jr., & McCrae, R. R. (1992a). NEO-PI-R professional manual. Odessa, FL: Psychological Assessment Resources. Costa, P. J., Jr., & McCrae, R. R., (1992b). Normal personality assessment in clinical practice: The NEO Personality Inventory. Psychological Assessment, 4, Costa, P. J., Jr., & McCrae, R. R. (1992c). Trait psychology comes of age. In T. B. Sonderegger (Ed.), Nebraska Symposium on Motivation: Psychology and Aging (pp ). Lincoln, NE: University of Nebraska Press. Costa, P. J., Jr., & McCrae, R. R. (1995). Domains and facets: Hierarchical personality assessment using the Revised NEO Personality Inventory. Journal of Personality Assessment, 64, Crocker, A. G., Mueser, K. T., Drake, R. E., Clark, R. E., McHugo, G. J., Ackerson, T. H., et al. (2005). Antisocial personality, psychopathy, and violence in persons with dual disorders: A longitudinal analysis. Criminal Justice and Behavior, 32, Cyders, M. A., Smith, G. T., Spillane, N. S., Fischer, S., Annus, A. M., & Peterson, C. (2007). Integration of impulsivity and positive mood to predict risky behavior: Development and validation of a measure of positive urgency. Psychological Assessment, 19, De Fruyt, F., De Bolle, M., McCrae, R. R., Terracciano, A., & Costa, P. T. (2009). Assessing the universal structure of personality in early adolescence. Assessment, 16, Depue, R. A., & Collins, P. F. (1999). Neurobiology of the structure of personality: Dopamine, facilitation of incentive motivation, and extraversion. Behavioral and Brain Sciences, 22, Derogatis, L. R. (1993). Brief Symptom Inventory: Administration, scoring, and procedures manual. Minneapolis: National Computer Systems. Diamond, P. M., & Magaletta, P. R. (2006). The short-form Buss Perry Aggression Questionnaire (BPAQ-SF): A validation study with federal offenders. Assessment, 13, Eysenck, H. J., & Eysenck, S. B. G. (1975). Manual of the Eysenck personality questionnaire (adult and junior). London: Hodder and Stoughton. Grant B. F., Chou, S. P., Goldstein, R. B., Huang, B., Frederick, S. S., Saha, T. D., et al. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: Results from the wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychology, 69, Hicklin, J., & Widiger, T. A. (2005). Similarities and differences among antisocial and psychopathic self-report inventories from the perspective of general personality functioning. European Journal of Personality, 19, Jacobo, M. C., Blais, M. A., Baity, M. R., & Harley, R. (2007). Concurrent validity of the Personality Assessment Inventory borderline scales in patients seeking dialectical behavior therapy. Journal of Personality Assessment, 88, Kurtz, J. E., & Morey, L. C. (2001). Use of structured self-report assessment to diagnose borderline personality disorder during major depressive episodes. Assessment, 8, Kurtz, J. E., Morey, L. C., & Tomarken, A. J. (1993). The concurrent validity of three self-report measures of borderline personality. Journal of Psychopathology and Behavioral Assessment, 15, Levenson, M., Kiehl, K., & Fitzpatrick, C. (1995). Assessing psychopathic attributes in a noninstitutionalized population. Journal of Personality and Social Psychology, 68, Lofgren, D. P., Bemporad, J., King, J., & Lindem, K. (1991). A prospective followup study of so-called borderline children. American Journal of Psychiatry, 148, Lynam, D. R., Whiteside, S., & Jones, S. (1999). Self-reported psychopathy: A validation study. Journal of Personality Assessment, 73, Markon, K. E., Krueger, R. F., & Watson, D. (2005). Delineating the structure of normal and abnormal personality: An integrative hierarchical approach. Jour-

13 156 DESHONG AND KURTZ nal of Personality and Social Psychology, 88, McCrae, R. R., & Costa, P. T. (1996). Toward a new generation of personality theories: Theoretical contexts for the fivefactor model. In J. S. Wiggins (Ed.), The five-factor model of personality: Theoretical perspectives (pp ). New York: Guilford Press. McCrae, R. R., & Costa, P. T. (2010). NEO Inventories professional manual. Lutz, FL: Psychological Assessment Resources, Inc. McCrae, R. R., Kurtz, J. E., Yamagata, S., & Terracciano, A. (2011). Internal consistency, retest reliability, and their implications for personality scale validity. Personality and Social Psychology Review, 15, Miller, J., Flory, K., Lynam, D., & Leukefeld, C. (2003). A test of the four-factor model of impulsivity-related traits. Personality and Individual Differences, 34, Morey, L. C. (1991). Personality Assessment Inventory professional manual. Lutz, FL: Psychological Assessment Resources, Inc. Paris, J. (1997). Antisocial and borderline personality disorders: Two separate diagnoses or two aspects of the same psychopathology? Comprehensive Psychiatry, 38, Robins, L., Cottler, L., Bucholz, K., & Compton, W. (1997). Diagnostic Interview Schedule for the DSM-IV (DIS-IV). St. Louis: Washington University School of Medicine. Salekin, R. T., Trobst, K. K., & Krioukova, M. (2001). Construct validity of psychopathy in a community sample: A nomological net approach. Journal of Personality Disorders, 15, Tellegen, A. (1982). Multidimensional Personality Questionnaire manual. Minneapolis, MN: University of Minnesota Press. Tellegen, A. (1985). Structure of mood and personality and their relevance to assessing anxiety, with an emphasis on self-report. In A. H. Tuma & J. D. Maser (Eds.), Anxiety and the anxiety disorders (pp ). Minneapolis, MN: University of Minnesota Press. Tragesser, S. L., & Robinson, R. J. (2009). The role of affective instability and UPPS impulsivity in borderline personality disorder features. Journal of Personality Disorders, 23, Trull, T. J. (1995). Borderline personality disorder features in nonclinical young adults: I. Identification and validation. Psychological Assessment, 7, Trull, T. J. (1997). Borderline personality disorder features in nonclinical young adults: 2. Two year outcome. Journal of Abnormal Psychology, 106, Whiteside, S. P., & Lynam, D. R. (2001). The five-factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, Whiteside, S. P., Lynam, D. R., Miller, J. D., & Reynolds, S. K. (2005). Validation of the UPPS impulsive behavior scale: A four-factor model of impulsivity. European Journal of Personality, 19, Zanarini, M. C., Frankenburg, F. R., Dubo, E. D., Sickel, A. E., Trikha, A., Levin, A., et al. (1998). Axis II comorbidity of borderline personality disorder. Comprehensive Psychiatry, 39, Zimmerman, M., Rothschild, L., & Chelminski, I. (2005). The prevalence of DSM- IV personality disorders in psychiatric outpatients. American Journal of Psychiatry, 162, Zuckerman, M., Kuhlman, D. M., Joireman, J., Teta, P., & Kraft, M. (1993). A comparison of three structural models of personality: The big three, the big five, and the alternative five. Journal of Personality and Social Psychology, 65,