Ipo Inventory For Personality Organization

Ipo inventory for personality organization

Abstract

Background

The Inventory of Personality Organisation (IPO) is a self-report measure that reflects personality traits, as theorised by Kernberg.

Methods

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).

Results

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.

Conclusion

Although losing more than 40% of the original items, the Japanese IPO may be a reliable and valid measure of Kernberg's personality organisation for Japanese populations.

Background

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) [1] 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.

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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 [6].

Kernberg and colleagues thus developed a self-report to operationalise personality organisation: the Inventory of Personality Organisation (IPO) [7]. 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 [8].

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.

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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.

Study 1

Methods

Participants

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).

Ipo inventory for personality organization

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.

Measurement

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 [5] 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.

Procedure

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.

Statistical analysis

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).

Ipo inventory for personality organization

All factors were considered dependent upon each other. The factor solution was sought after promax rotation, which is a diagonal rotation.

Table 1

Means and standard deviations (SDs) of the Inventory of Personality Organisation (IPO) items (N = 353)

No.CategoryQuestionMeanSD
1PDI am a 'hero worshiper'1.821.00

2PDPeople I once thought highly of have disappointed me2.381.01

3PDIt has been a long time since anyone taught me anything I did not know1.991.02

4PDPeople turn against me or betray me1.831.05

5PDI admire people in order to feel secure2.541.08

6PD
MV
I do things that at other times I think are not too wise1.901.09

7PDI have difficulty in seeing shortcomings in those I admire1.27.061

8PDI don't get what I want2.501.22

9PDI behave in contradictory ways1.831.01

10PDPeople are basically either good or bad1.781.06

11PDPeople use me1.750.98

12PDI act in unpredictable and erratic ways2.451.15

13PDI have favourite people whom I idealise2.621.27

14PD
MV
I do things that I later find hard to believe I did2.591.05

15PDPeople either overwhelm me with love or abandon me1.620.96

16PDI feel things with either joy or despair2.221.19

17ID
MV
Others see me as quite different from the way I really am1.711.05

18IDI'm different at home than I am at work/school2.461.33

19IDMy tastes and opinions are borrowed from other people1.861.03

20IDI behave differently in different situations2.411.22

21IDI fluctuate between being warm and cold2.771.23

22IDI provoke people to get my way1.410.79

23IDI can't explain the changes in my behaviour1.931.14

24IDI do things on impulse that are socially unacceptable2.141.07

25IDIt's hard for me to say no2.351.18

26IDMy life seems like a series of short stories1.961.24

27IDI pick up interests and then drop them2.171.16

28IDWhen others see me as having succeeded, I'm elated2.791.31

29IDImportant people suddenly change their attitudes towards me3.361.31

30IDIt is hard for me to be sure about what others think of me3.301.27

31IDBeing alone is difficult2.101.14

32IDI see myself in different ways at different times2.601.23

33IDIn an intimate relationship, I'm afraid of losing a sense of myself1.871.18

34IDMy life goals change frequently2.251.19

35IDMy goals keep changing2.421.24

36IDAfter being involved with people, I find out what they are really like2.551.13

37IDPeople cannot guess how I'm going to behave2.291.17

38RTWhen everything is confused, I feel that way inside2.711.27

39RTI am not sure whether a voice I have heard is my imagination1.671.00

40RTWhen I am confused, things in the outside world don't make sense either2.301.26

41RTI feel as if I'm someone else1.530.89

42RTI see things that turn out to be something else1.570.90

43RTWhen uncomfortable, I can't tell whether it is emotional or physical2.061.10

44RTI can see/hear things that nobody else can see/hear1.350.76

45RTI hear things that are not really there1.310.73

46RTI have heard or seen things without apparent reason1.350.77

47RTI do things to upset other people1.620.94

48RTI can't tell whether certain physical sensations are real1.390.80

49RTMy wishes/thoughts will come true as if by magic1.540.87

50RTPeople see me as rude or inconsiderate1.390.76

51RTI understand things that nobody else is able to understand1.580.76

52RTI cannot tell when certain things would appear crazy to others1.520.88

53RTI have seen things that do not exist1.280.76

54RTI feel as if I have been somewhere before when I really haven't2.321.16

55RTI can't tell whether I simply want something to be true1.450.87

56RTThings will happen by thinking about them1.380.75

57RTI never know how to conduct myself with people1.661.01

58AGI enjoy seeing other people suffer1.340.75

59AGWhen we disagreed about how to solve a problem, I couldn't stand it1.480.91

60AGI have intentionally harmed someone1.961.06

61AGTo maintain control, you have to make people afraid of you1.490.88

62AGI have seriously harmed someone in self-defence1.911.09

63AGI control others by making them feel guilty1.220.63

64AGI inflict physical harm on others1.140.54

65AGI neglect my physical health1.450.84

66AGYou can obtain what you want by hurting yourself1.260.77

67AGI like having others afraid of me1.190.57

68AGI can't resist doing things which others consider hurtful but relieve tension1.190.59

69AGThe suffering of other people is exciting1.190.59

70AGWhen people don't understand/mess things up I become hostile2.021.15

71AGI enjoy making other people suffer1.170.56

72AGIt is a big relief to cause physical pain to myself1.130.48

73AGI enjoy dangerous activities1.230.60

74AGI have made an attempt at suicide1.180.57

75AGI lose my patience and later regret it1.761.02

76MVEverybody would steal if not afraid1.791.14

77MVI feel justified in taking things that aren't mine if I can do so safely1.310.74

78MVThere are periods of time when I've acted in an immoral or amoral way1.730.93

79MVPeople pretend to feel guilty when afraid of being caught1.46.077

80MVEverybody is out to get things for themselves1.550.91

81MVOne cannot judge others' real feelings from their surface behaviour2.161.20

82MVEverybody pretends to be concerned about others and moral values1.500.83

83MVI'm free of guilty feelings1.460.90

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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.

Ipo inventory for personality organization

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 [8].

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).

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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 [10].

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).

Results

Basic statistics

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.

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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.

Factor structure

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.

Background

Thus, we also excluded these items from the subsequent analyses.

Table 2

Exploratory factor analysis of the primary Inventory of Personality Organisation (IPO) items (N = 353)

No.QuestionFactor

123
29Important people suddenly change towards me0.80-0.12-0.05

38When everything is confused, I feel that way inside0.730.00-0.06

28When others see me as having succeeded, I'm elated0.64-0.070.05

36After being involved with people, I find out what they are really like0.630.000.07

30It is hard for me to be sure about what others think of me0.62-0.280.24

35My goals keep changing0.540.38-0.30

34My life goals change frequently0.520.38-0.33

27I pick up interests and then drop them0.500.21-0.18

31Being alone is difficult0.48-0.06-0.22

20I behave differently in different situations0.47-0.220.41

32I see myself in different ways at different times0.460.170.10

25It's hard for me to say no0.460.040.03

21I fluctuate between being warm and cold0.43-0.140.42

14I do things that I later find hard to believe I did0.400.130.19

33In an intimate relationship, I'm afraid of losing a sense of myself0.400.36-0.10

40When I am confused, things in the outside world don't make sense either0.400.310.05

5I admire people in order to feel secure0.37-0.190.33

24I do things on impulse that are socially acceptable0.320.050.29

37People cannot guess how I'm going to behave0.320.140.22

6I do things that at other times I think are unwise0.320.090.07

26My life seems like a series of short stories0.320.220.02

19My tastes and opinions are borrowed from other people0.290.150.21

13I have favourite people whom I idealise0.21-0.020.12

55I can't tell whether I simply want something to be true-0.040.85-0.04

42I see things that turn out to be something else-0.010.730.00

51I understand things that nobody else is able to understand-0.080.680.10

39I am not sure whether a voice I have heard is my imagination0.070.63-0.01

54I feel as if I have been somewhere before when I really haven't-0.020.61-0.04

43When uncomfortable, I can't tell whether it is emotional or physical0.130.550.01

41I feel as if I'm someone else0.060.540.12

47I do things to upset other people-0.080.530.14

52I cannot tell when certain things would appear crazy to others-0.040.510.21

49My wishes/thoughts will come true as if by magic-0.150.490.08

57I never know how to conduct myself with people0.130.460.19

4People turn against me or betray me-0.12-0.050.69

11People use me-0.03-0.070.64

15People either overwhelm me with love or abandon me-0.170.270.61

10People are basically either good or bad-0.320.150.58

17Others see me as quite different from the way I really am0.080.110.53

12I act in unpredictable and erratic ways0.130.010.52

22I provoke people to get my way-0.110.310.51

8I don't get what I want0.130.020.46

16I feel things with either joy or despair0.170.150.44

18I'm different at home than at work/school0.33-0.010.40

3It has been a long time since anyone taught me anything I did not know-0.140.260.39

9I behave in contradictory ways0.040.320.36

1I am a 'hero worshiper'-0.020.040.34

2People I once thought highly of have disappointed me0.190.060.33

23I can't explain changes in my behaviour0.170.070.33

Percentage variance explained28.6%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.

Table 3

Revised exploratory factor analysis of the primary Inventory of Personality Organisation (IPO) items (N = 353)

No.QuestionFactor

123
55I can't tell whether I simply want something to be true0.85-0.100.01

42I see things that turn out to be something else0.75-0.060.02

51I understand things that nobody else is able to understand0.73-0.080.06

54I feel as if I have been somewhere before when I really haven't0.64-0.08-0.01

39I am not sure whether a voice I have heard is my imagination0.630.020.04

49My wishes/thoughts will come true as if by magic0.59-0.17-0.03

47I do things to upset other people0.57-0.030.06

52I cannot tell when certain things would appear crazy to others0.560.010.11

41I feel as if I'm someone else0.540.040.16

43When uncomfortable, I can't tell whether it is emotional or physical0.540.100.06

57I never know how to conduct myself with people0.480.170.15

29Important people suddenly change towards me-0.110.780.01

28When others see me as having succeeded, I'm elated-0.040.70-0.02

30It is hard for me to be sure about what others think of me-0.240.690.22

36After being involved with people, I find out what they are really like0.030.640.08

20I behave differently in different situations-0.110.560.30

34My life goals change frequently0.380.50-0.37

35My goals keep changing0.400.49-0.30

25It's hard for me to say no0.040.450.08

27I pick up interests and then drop them0.180.45-0.10

32I see myself in different ways at different times0.200.450.12

31Being alone is difficult-0.180.43-0.05

11People use me-0.050.070.71

4People turn against me or betray me-0.020.020.67

10People are basically either good or bad0.18-0.220.57

15People either overwhelm me with love or abandon me0.33-0.040.51

12I act in unpredictable and erratic ways0.120.190.40

8I don't get what I want0.070.290.36

Percentage variance explained29.4%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.

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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).

Table 4

Exploratory factor analysis of the additional Inventory of Personality Organisation (IPO) items (N = 353)

No.QuestionFactor

12
59When we disagreed about how to solve a problem, I couldn't stand it0.84-0.16

62I have seriously harmed someone in self-defence0.79-0.11

60I have intentionally harmed someone0.750.01

61To maintain control, you have to make people afraid of you0.640.11

14I do things that I later find hard to believe I did0.62-0.14

17Others see me as quite different from the way I really am0.620.00

75I lose my patience and later regret it0.550.20

70When people don't understand/mess things up I become hostile0.470.33

6I do things that at other times I think are not too wise0.270.14

80Everybody is out to get things for themselves-0.210.85

79People pretend to feel guilty when afraid of being caught-0.170.79

81One cannot judge others' real feelings from their surface behaviour0.090.63

76Everybody would steal if not afraid0.040.60

82Everybody pretends to be concerned about others and moral values0.220.58

78There are periods of time when I've acted in an immoral or amoral way0.280.51

83I'm free of guilty feelings-0.060.50

65I neglect my physical health0.210.29

Percentage variance explained35.2%8.0%

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