- The Inventory of Personality Organization–Revised
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- Study 1
- Ipo inventory for personality organization
- Table 1
- Individual Offers
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- Table 3
- Personality functioning in anxiety disorders
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The Inventory of Personality Organisation (IPO) is a self-report measure that reflects personality traits, as theorised by Kernberg.
In study 1, the Japanese version of the IPO was distributed to a population of Japanese university students (N = 701).
The students were randomly divided into two groups. The factor structure derived from an exploratory factor analysis among one subsample was tested using a confirmatory factor structure among another subsample.
The Inventory of Personality Organization–Revised
In study 2, the factor-driven subscales of the IPO were correlated with other variables that would function as external criteria to validate the scale in a combined population of the students used in study 1 and psychiatric outpatients (N = 177).
In study 1 the five-factor structure presented by the original authors was replicated in exploratory factor analyses in one subgroup of students.
However, this was through reduction of the number of items (the number of the primary items was reduced from 57 to 24 whereas the number of the additional items was reduced from 26 to 13) due to low endorsement frequencies as well as low factor loadings on a designated factor.
The new factor structure was endorsed by a confirmatory factor analysis in the other student subgroup. In study 2 the new five subscales of the Japanese IPO were likely to be correlated with younger age, more personality psychopathology (borderline and narcissistic), more dysphoric mood, less psychological well-being, more insecure adult attachment style, lower self-efficacy, and more frequent history of childhood adversity.
The IPO scores were found to predict the increase in suicidal ideation in a week's time in a longitudinal follow-up.
The classification and diagnosis of personality disorders have long interested clinicians and researchers.
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Those patients with such terminologies as pseudoneuroses and latent schizophrenia have been thought to be 'located' between neuroses and psychoses. These clinical conditions were recognised as borderline personality pathology and categorised as a personality disorder in the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III)  based on their patterns of cognition, affectivity, interpersonal functioning, and impulse control.
They are of particular clinical importance due to their treatment resistance. Studies of psychological therapies for borderline personality disorder have been published primarily as a compilation of cases lacking empirical data. However, a randomised control trial was recently reported [2,3].
Contrary to the descriptive approaches adopted by the DSM, Kernberg [4,5] proposed a personality structure consisting of three layers: neurotic, borderline, and psychotic.
This classification was derived from psychoanalytic theory. According to Kernberg's theory, borderline personality organisation could be characterised by (1) non-specific manifestation of ego weakness, such as lack of anxiety tolerance, lack of impulse control, and lack of developed sublimatory channels; (2) a shift towards primary-process thinking; (3) specific defensive operations, such as splitting, primitive idealisation, early forms of projection and projective identification, denial, and omnipotence and devaluation; and (4) the pathology of internalised object relationships.
These considerations are important because although the pathological diagnosis of personality disorders is reliably based on the behavioural descriptions detailed in the DSM, insight-oriented psychotherapies such as psychoanalysis do not target these behavioural manifestations but rather the changes in a person's in-depth personality that can only be measured using concepts matching the therapeutic theory described above.
Understanding a client's personality organisation is important when planning treatment and observing its results, but the primary means of assessing personality structure has been interviews, which are difficult to standardise .
Kernberg and colleagues thus developed a self-report to operationalise personality organisation: the Inventory of Personality Organisation (IPO) . This instrument assesses three domains: primitive psychological defences, reality testing, and identity diffusion. To these, the authors also added two supplementary scales: aggression and moral value. The reliability and validity of the original IPO has been confirmed .
The present study is a preliminary report using the IPO, which we translated into Japanese, in Japanese non-clinical (undergraduate student) and clinical populations.
We examined the factor structure of the inventory by both exploratory and confirmatory factor analyses.
Its concurrent validity was examined by using the self-report measures of borderline and narcissistic personality disorders. We also hypothesised that psychological maladjustment (for example, negative affects including depression and anxiety, poor psychological well-being, insecure adult attachment style, low self efficacy, and history of childhood adversities) would be stronger in those with more severe borderline personality pathology.
Dr. Otto Kernberg Masterclass - "Personality and Personality Disorders: An overview" (Part 1/3)
Finally, the predictive validity of the Japanese IPO was examined in terms of predicting suicidal ideation in weekly follow-up of the students.
Students from five universities in Tokyo and Kumamoto were solicited to participate in a questionnaire survey.
Usable data were available from 701 students, 172 men and 529 women. Their mean (standard deviation (SD)) age was 19.6 (2.3) years old with the range between 18 and 40. Men (mean = 20.0, SD = 2.5) were slightly but significantly (t = 2.9 P < 0.01) older than women (mean = 19.4, SD = 2.2).
Because we asked lecturers of each university to distribute the questionnaire we were unaware of the exact number of students who were solicited. Hence we had no means to compare students who participated in the study and those who did not in terms of key variables.
Personality organisation: the IPO is a self-report measure consisting of 83 items on a 5-point scale from 'never true = 1' to 'always true = 5'.
This tool was developed based on the central dimension of Kernberg's  personality organisation model: primitive psychological defences, identity diffusion, and reality testing. These dimensions are measured by the 3 primary scales of the IPO: Primitive Defences (16 items), Identity Diffusion (21 items), and Reality Testing (20 items). Added to these are 2 additional scales, Aggression (18 items) and Moral Values (8 items with 2 Primitive Defences items and 1 Identity Diffusion item).
The psychometric properties of the original IPO have been reported previously [8,9]. With the original author's permission, we translated this inventory into Japanese.
Ipo inventory for personality organization
In order to verify the accuracy of the Japanese translation, a translator unfamiliar with the original document back-translated the Japanese version into English.
All the questionnaires were anonymously distributed and collected in a university class. This project was approved by the Ethical Committee of Kumamoto University Graduate School of Medical Sciences.
First, we examined the means and SDs of all the IPO items among the 701 students.
Then after randomly dividing the students into two groups, we performed a series of exploratory factor analyses (EFA) separately for the primary and additional items of the IPO using data from one group of students. Because inclusion of items with a low base rate in an EFA may cause distorted structure, we excluded items from analyses if their mean was less than 1.4, which is 1/10th from the lowest score of 1 within a range of 4 (Table 1).
All factors were considered dependent upon each other. The factor solution was sought after promax rotation, which is a diagonal rotation.
Means and standard deviations (SDs) of the Inventory of Personality Organisation (IPO) items (N = 353)
|1||PD||I am a 'hero worshiper'||1.82||1.00|
|2||PD||People I once thought highly of have disappointed me||2.38||1.01|
|3||PD||It has been a long time since anyone taught me anything I did not know||1.99||1.02|
|4||PD||People turn against me or betray me||1.83||1.05|
|5||PD||I admire people in order to feel secure||2.54||1.08|
|I do things that at other times I think are not too wise||1.90||1.09|
|7||PD||I have difficulty in seeing shortcomings in those I admire||1.27||.061|
|8||PD||I don't get what I want||2.50||1.22|
|9||PD||I behave in contradictory ways||1.83||1.01|
|10||PD||People are basically either good or bad||1.78||1.06|
|11||PD||People use me||1.75||0.98|
|12||PD||I act in unpredictable and erratic ways||2.45||1.15|
|13||PD||I have favourite people whom I idealise||2.62||1.27|
|I do things that I later find hard to believe I did||2.59||1.05|
|15||PD||People either overwhelm me with love or abandon me||1.62||0.96|
|16||PD||I feel things with either joy or despair||2.22||1.19|
|Others see me as quite different from the way I really am||1.71||1.05|
|18||ID||I'm different at home than I am at work/school||2.46||1.33|
|19||ID||My tastes and opinions are borrowed from other people||1.86||1.03|
|20||ID||I behave differently in different situations||2.41||1.22|
|21||ID||I fluctuate between being warm and cold||2.77||1.23|
|22||ID||I provoke people to get my way||1.41||0.79|
|23||ID||I can't explain the changes in my behaviour||1.93||1.14|
|24||ID||I do things on impulse that are socially unacceptable||2.14||1.07|
|25||ID||It's hard for me to say no||2.35||1.18|
|26||ID||My life seems like a series of short stories||1.96||1.24|
|27||ID||I pick up interests and then drop them||2.17||1.16|
|28||ID||When others see me as having succeeded, I'm elated||2.79||1.31|
|29||ID||Important people suddenly change their attitudes towards me||3.36||1.31|
|30||ID||It is hard for me to be sure about what others think of me||3.30||1.27|
|31||ID||Being alone is difficult||2.10||1.14|
|32||ID||I see myself in different ways at different times||2.60||1.23|
|33||ID||In an intimate relationship, I'm afraid of losing a sense of myself||1.87||1.18|
|34||ID||My life goals change frequently||2.25||1.19|
|35||ID||My goals keep changing||2.42||1.24|
|36||ID||After being involved with people, I find out what they are really like||2.55||1.13|
|37||ID||People cannot guess how I'm going to behave||2.29||1.17|
|38||RT||When everything is confused, I feel that way inside||2.71||1.27|
|39||RT||I am not sure whether a voice I have heard is my imagination||1.67||1.00|
|40||RT||When I am confused, things in the outside world don't make sense either||2.30||1.26|
|41||RT||I feel as if I'm someone else||1.53||0.89|
|42||RT||I see things that turn out to be something else||1.57||0.90|
|43||RT||When uncomfortable, I can't tell whether it is emotional or physical||2.06||1.10|
|44||RT||I can see/hear things that nobody else can see/hear||1.35||0.76|
|45||RT||I hear things that are not really there||1.31||0.73|
|46||RT||I have heard or seen things without apparent reason||1.35||0.77|
|47||RT||I do things to upset other people||1.62||0.94|
|48||RT||I can't tell whether certain physical sensations are real||1.39||0.80|
|49||RT||My wishes/thoughts will come true as if by magic||1.54||0.87|
|50||RT||People see me as rude or inconsiderate||1.39||0.76|
|51||RT||I understand things that nobody else is able to understand||1.58||0.76|
|52||RT||I cannot tell when certain things would appear crazy to others||1.52||0.88|
|53||RT||I have seen things that do not exist||1.28||0.76|
|54||RT||I feel as if I have been somewhere before when I really haven't||2.32||1.16|
|55||RT||I can't tell whether I simply want something to be true||1.45||0.87|
|56||RT||Things will happen by thinking about them||1.38||0.75|
|57||RT||I never know how to conduct myself with people||1.66||1.01|
|58||AG||I enjoy seeing other people suffer||1.34||0.75|
|59||AG||When we disagreed about how to solve a problem, I couldn't stand it||1.48||0.91|
|60||AG||I have intentionally harmed someone||1.96||1.06|
|61||AG||To maintain control, you have to make people afraid of you||1.49||0.88|
|62||AG||I have seriously harmed someone in self-defence||1.91||1.09|
|63||AG||I control others by making them feel guilty||1.22||0.63|
|64||AG||I inflict physical harm on others||1.14||0.54|
|65||AG||I neglect my physical health||1.45||0.84|
|66||AG||You can obtain what you want by hurting yourself||1.26||0.77|
|67||AG||I like having others afraid of me||1.19||0.57|
|68||AG||I can't resist doing things which others consider hurtful but relieve tension||1.19||0.59|
|69||AG||The suffering of other people is exciting||1.19||0.59|
|70||AG||When people don't understand/mess things up I become hostile||2.02||1.15|
|71||AG||I enjoy making other people suffer||1.17||0.56|
|72||AG||It is a big relief to cause physical pain to myself||1.13||0.48|
|73||AG||I enjoy dangerous activities||1.23||0.60|
|74||AG||I have made an attempt at suicide||1.18||0.57|
|75||AG||I lose my patience and later regret it||1.76||1.02|
|76||MV||Everybody would steal if not afraid||1.79||1.14|
|77||MV||I feel justified in taking things that aren't mine if I can do so safely||1.31||0.74|
|78||MV||There are periods of time when I've acted in an immoral or amoral way||1.73||0.93|
|79||MV||People pretend to feel guilty when afraid of being caught||1.46||.077|
|80||MV||Everybody is out to get things for themselves||1.55||0.91|
|81||MV||One cannot judge others' real feelings from their surface behaviour||2.16||1.20|
|82||MV||Everybody pretends to be concerned about others and moral values||1.50||0.83|
|83||MV||I'm free of guilty feelings||1.46||0.90|
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We were interested in developing a Japanese version of the instrument that would resemble the original as closely as possible in terms of item content and factor structure, rather than constructing a new personality measure using all the IPO items.
We therefore set the number of factors at three for the primary items and two for the additional items as suggested by the original authors. If we identified IPO items that loaded most highly on a factor other than the one that would have been expected from the original theory, we excluded them from the subsequent factor analyses (for example, if an item that was originally categorised as belonging to Reality Testing showed higher factor loading on the Identity Diffusion factor, we excluded it from the analysis).
We also excluded IPO items with factor loading of less than 0.45 from the subsequent factor analysis.
Thus, in the final factor analyses each factor contained a reduced number of items that belonged to the same category as defined in the original study .
In order to confirm the stability of the factor structures obtained from the above exploratory factor analyses, we performed a series of confirmatory factor analyses separately for the primary and additional items using another randomly generated subset of students. The fit of each model with the data was examined in terms of χ2 (CMIN), goodness-of-fit index (GFI), adjusted goodness-of-fit index (AGFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA).
According to conventional criteria, a good fit would be indicated by CMIN/df <2, GFI >0.95, AGFI >0.90, CFI >0.97, and RMSEA <0.05; an acceptable fit by CMIN/df <3, GFI >0.90, AGFI >0.85, CFI >0.95, and RMSEA <0.08 .
The Akaike Information Criterion (AIC) was used to compare different models; a model with an AIC at least 2 points lower is regarded as a better model.
All the statistical analyses were conducted using SPSS version 14.0 (SPSS, Chicago, IL, USA) and Amos version 6.0 (SPSS).
Means and SDs of all the IPO items among all students are presented in Table 1.
The mean of 20 items was less than 1.4.
The score of 1 ('never true') was reported by 75.1% to 92.1% of the participants for such items. Thus, they were excluded from subsequent factor analyses.
We performed an exploratory factor analysis on all items originally categorised as primary, using a randomly selected subset of students (N = 353).
This showed that (1) almost all items with high factor loadings on the first factor were those originally categorised as Identity Diffusion; (2) all items with high factor loadings on the second factor were those originally categorised as Reality Testing; (3) almost all items with high factor loadings on the third factor were those originally categorised as Primitive Defence (Table 2).
However, 18 items showed no loading of up to 0.45 or more for all three factors, and we therefore excluded these items from the subsequent analyses. Items 38 (originally a Reality Testing item), 17 (originally an Identity Diffusion item), and 22 (originally an Identity Diffusion item) showed a factor loading of 0.45 or more but these were found not to belong to the factor of their original category.
Thus, we also excluded these items from the subsequent analyses.
Exploratory factor analysis of the primary Inventory of Personality Organisation (IPO) items (N = 353)
|29||Important people suddenly change towards me||0.80||-0.12||-0.05|
|38||When everything is confused, I feel that way inside||0.73||0.00||-0.06|
|28||When others see me as having succeeded, I'm elated||0.64||-0.07||0.05|
|36||After being involved with people, I find out what they are really like||0.63||0.00||0.07|
|30||It is hard for me to be sure about what others think of me||0.62||-0.28||0.24|
|35||My goals keep changing||0.54||0.38||-0.30|
|34||My life goals change frequently||0.52||0.38||-0.33|
|27||I pick up interests and then drop them||0.50||0.21||-0.18|
|31||Being alone is difficult||0.48||-0.06||-0.22|
|20||I behave differently in different situations||0.47||-0.22||0.41|
|32||I see myself in different ways at different times||0.46||0.17||0.10|
|25||It's hard for me to say no||0.46||0.04||0.03|
|21||I fluctuate between being warm and cold||0.43||-0.14||0.42|
|14||I do things that I later find hard to believe I did||0.40||0.13||0.19|
|33||In an intimate relationship, I'm afraid of losing a sense of myself||0.40||0.36||-0.10|
|40||When I am confused, things in the outside world don't make sense either||0.40||0.31||0.05|
|5||I admire people in order to feel secure||0.37||-0.19||0.33|
|24||I do things on impulse that are socially acceptable||0.32||0.05||0.29|
|37||People cannot guess how I'm going to behave||0.32||0.14||0.22|
|6||I do things that at other times I think are unwise||0.32||0.09||0.07|
|26||My life seems like a series of short stories||0.32||0.22||0.02|
|19||My tastes and opinions are borrowed from other people||0.29||0.15||0.21|
|13||I have favourite people whom I idealise||0.21||-0.02||0.12|
|55||I can't tell whether I simply want something to be true||-0.04||0.85||-0.04|
|42||I see things that turn out to be something else||-0.01||0.73||0.00|
|51||I understand things that nobody else is able to understand||-0.08||0.68||0.10|
|39||I am not sure whether a voice I have heard is my imagination||0.07||0.63||-0.01|
|54||I feel as if I have been somewhere before when I really haven't||-0.02||0.61||-0.04|
|43||When uncomfortable, I can't tell whether it is emotional or physical||0.13||0.55||0.01|
|41||I feel as if I'm someone else||0.06||0.54||0.12|
|47||I do things to upset other people||-0.08||0.53||0.14|
|52||I cannot tell when certain things would appear crazy to others||-0.04||0.51||0.21|
|49||My wishes/thoughts will come true as if by magic||-0.15||0.49||0.08|
|57||I never know how to conduct myself with people||0.13||0.46||0.19|
|4||People turn against me or betray me||-0.12||-0.05||0.69|
|11||People use me||-0.03||-0.07||0.64|
|15||People either overwhelm me with love or abandon me||-0.17||0.27||0.61|
|10||People are basically either good or bad||-0.32||0.15||0.58|
|17||Others see me as quite different from the way I really am||0.08||0.11||0.53|
|12||I act in unpredictable and erratic ways||0.13||0.01||0.52|
|22||I provoke people to get my way||-0.11||0.31||0.51|
|8||I don't get what I want||0.13||0.02||0.46|
|16||I feel things with either joy or despair||0.17||0.15||0.44|
|18||I'm different at home than at work/school||0.33||-0.01||0.40|
|3||It has been a long time since anyone taught me anything I did not know||-0.14||0.26||0.39|
|9||I behave in contradictory ways||0.04||0.32||0.36|
|1||I am a 'hero worshiper'||-0.02||0.04||0.34|
|2||People I once thought highly of have disappointed me||0.19||0.06||0.33|
|23||I can't explain changes in my behaviour||0.17||0.07||0.33|
|Percentage variance explained||28.6%||4.5%||3.5%|
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We then factor analysed the remaining 28 primary items (Table 3).
All the items with high factor loadings on the first factor belonged to Reality Testing, all the items with high factor loadings on the second factor belonged to Identity Diffusion, and all the items with high factor loadings on the third factor belonged to Primitive Defence. However, four items (items 8, 12, 31, and 32) showed a factor loading of less than 0.45 and we therefore dropped from the final subscale construction. Our dataset ultimately consisted of 11 items for Reality Testing, 9 items for Identity Diffusion, and 4 items for Primitive Defence.
Revised exploratory factor analysis of the primary Inventory of Personality Organisation (IPO) items (N = 353)
|55||I can't tell whether I simply want something to be true||0.85||-0.10||0.01|
|42||I see things that turn out to be something else||0.75||-0.06||0.02|
|51||I understand things that nobody else is able to understand||0.73||-0.08||0.06|
|54||I feel as if I have been somewhere before when I really haven't||0.64||-0.08||-0.01|
|39||I am not sure whether a voice I have heard is my imagination||0.63||0.02||0.04|
|49||My wishes/thoughts will come true as if by magic||0.59||-0.17||-0.03|
|47||I do things to upset other people||0.57||-0.03||0.06|
|52||I cannot tell when certain things would appear crazy to others||0.56||0.01||0.11|
|41||I feel as if I'm someone else||0.54||0.04||0.16|
|43||When uncomfortable, I can't tell whether it is emotional or physical||0.54||0.10||0.06|
|57||I never know how to conduct myself with people||0.48||0.17||0.15|
|29||Important people suddenly change towards me||-0.11||0.78||0.01|
|28||When others see me as having succeeded, I'm elated||-0.04||0.70||-0.02|
|30||It is hard for me to be sure about what others think of me||-0.24||0.69||0.22|
|36||After being involved with people, I find out what they are really like||0.03||0.64||0.08|
|20||I behave differently in different situations||-0.11||0.56||0.30|
|34||My life goals change frequently||0.38||0.50||-0.37|
|35||My goals keep changing||0.40||0.49||-0.30|
|25||It's hard for me to say no||0.04||0.45||0.08|
|27||I pick up interests and then drop them||0.18||0.45||-0.10|
|32||I see myself in different ways at different times||0.20||0.45||0.12|
|31||Being alone is difficult||-0.18||0.43||-0.05|
|11||People use me||-0.05||0.07||0.71|
|4||People turn against me or betray me||-0.02||0.02||0.67|
|10||People are basically either good or bad||0.18||-0.22||0.57|
|15||People either overwhelm me with love or abandon me||0.33||-0.04||0.51|
|12||I act in unpredictable and erratic ways||0.12||0.19||0.40|
|8||I don't get what I want||0.07||0.29||0.36|
|Percentage variance explained||29.4%||6.7%||5.3%|
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We then performed confirmatory factor analyses (CFA) of the final 24 primary items using the other group of students (N = 348).
In the initial model we posited covariances between all three factors; this barely failed to reach an acceptable level of significance: χ2/df = 2.9, GFI = 0.845, AGFI = 0.813, CFI = 0.796, RMSEA = 0.075, AIC = 836.0.
Personality functioning in anxiety disorders
Taking into account the greatest modification index of covariance, we developed a revised model (Figure 1) that fit the data better: χ2/df = 1.8, GFI = 0.905, AGFI = 0.883, CFI = 0.919, RMSEA = 0.048, AIC = 548.8.
Similarly we performed an EFA of the additional items of the IPO. It is of note that the original concept included under the rubric of 'additional items' three items (items 6, 14, and 17) that were also categorised as primary items.
Almost all the items with high factor loadings on the first factor were those originally categorised as Aggression. Almost all the items with high factor loadings on the second factor were those originally categorised as Moral Value (Table 4).
However, two items showed no factor loading of up to 0.45 or more for both factors. In addition, items 14 and 17 (originally Moral Value items) showed a factor loading of 0.45 or more on the first factor. These factors were excluded before repeating the EFA. The revised EFA yielded two factors with six and seven items, respectively (Table 5).
Exploratory factor analysis of the additional Inventory of Personality Organisation (IPO) items (N = 353)
|59||When we disagreed about how to solve a problem, I couldn't stand it||0.84||-0.16|
|62||I have seriously harmed someone in self-defence||0.79||-0.11|
|60||I have intentionally harmed someone||0.75||0.01|
|61||To maintain control, you have to make people afraid of you||0.64||0.11|
|14||I do things that I later find hard to believe I did||0.62||-0.14|
|17||Others see me as quite different from the way I really am||0.62||0.00|
|75||I lose my patience and later regret it||0.55||0.20|
|70||When people don't understand/mess things up I become hostile||0.47||0.33|
|6||I do things that at other times I think are not too wise||0.27||0.14|
|80||Everybody is out to get things for themselves||-0.21||0.85|
|79||People pretend to feel guilty when afraid of being caught||-0.17||0.79|
|81||One cannot judge others' real feelings from their surface behaviour||0.09||0.63|
|76||Everybody would steal if not afraid||0.04||0.60|
|82||Everybody pretends to be concerned about others and moral values||0.22||0.58|
|78||There are periods of time when I've acted in an immoral or amoral way||0.28||0.51|
|83||I'm free of guilty feelings||-0.06||0.50|
|65||I neglect my physical health||0.21||0.29|
|Percentage variance explained||35.2%||8.0%|
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