Clinical Practice & Epidemiology in Mental Health




ISSN: 1745-0179 ― Volume 16, 2020
RESEARCH ARTICLE

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



Olga Coelho1, *, Rute Pires1, 2, Ana Sousa Ferreira2, 3, Bruno Gonçalves1, 2, Maryam AlJassmi4, Joana Stocker4
1 CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
2Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal
3Instituto Universitário de Lisboa (ISCTE-IUL), Business Research Unit, Av. das Forças Armadas, 1649-026 Lisboa, Portugal
4 College of Natural and Health Sciences, Zayed University, P.O. Box 19282 Dubai, U.A.E

Abstract

Background:

Section III of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) proposes a model for conceptualizing personality disorders in which they are characterized by impairments in personality functioning and maladaptive personality traits. The Personality Inventory for DSM-5 (PID-5) is a self-report measure that assesses the presence and severity of these maladaptive personality traits.

Objective:

The current study examined the reliability and validity of the Arabic version of the Personality Inventory for DSM-5 (PID-5) to measure maladaptive personality traits in the Emirati population of the United Arab Emirates.

Methods:

The Arabic version of the PID-5 was administered to a community sample of 1,090 United Arab Emirates nationals (89.5% female and 10.5% male, mean age = 22.44 years old). The descriptive measures, internal consistency, test-retest reliability, convergent validity with NEO – Five Factor Inventory, as well as PID-5’s factor structure, were all addressed.

Results:

The PID-5facets and domains mean scores were higher in the Emirati sample compared to the original US sample. Internal consistency of the PID-5 scales was acceptable to high and test-retest coefficients ranged from 0.84 (facets) to 0.87 (domains). As expected, the five domains of the Arabic version of the PID-5 correlated significantly with all Five-Factor Model domains of personality. Additionally, the Arabic version of the PID-5 confirmed a five-factor structure that resembles the PID-5 domains.

Conclusion:

The findings of this study provided initial support for the use of the Arabic version of the PID-5 to assess maladaptive personality traits in the Emirati population of the United Arab Emirates.

Keywords: Personality, DSM-5,Personality trait model, PID-5, United Arab Emirates, Psychometric properties.


Article Information


Identifiers and Pagination:

Year: 2020
Volume: 16
First Page: 180
Last Page: 188
Publisher Id: CPEMH-16-180
DOI: 10.2174/1745017902016010180

Article History:

Received Date: 11/03/2020
Revision Received Date: 30/05/2020
Acceptance Date: 31/05/2020
Electronic publication date: 30/07/2020
Collection year: 2020

© 2020 Coelho et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013 Lisboa, Portugal, E-mail: ocoelho@edu.ulisboa.pt





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 [1Krueger RF, Markon KE. The role of the DSM-5 personality trait model in moving toward a quantitative and empirically based approach to classifying personality and psychopathology. Annu Rev Clin Psychol 2014; 10: 477-501.
[http://dx.doi.org/10.1146/annurev-clinpsy-032813-153732] [PMID: 24329179]
, 2Tyrer P, Reed GM, Crawford MJ. Classification, assessment, prevalence, and effect of personality disorder. Lancet 2015; 385(9969): 717-26.
[http://dx.doi.org/10.1016/S0140-6736(14)61995-4] [PMID: 25706217]
] with limited clinical utility [3Hopwood CJ, Kotov R, Krueger RF, et al. The time has come for dimensional personality disorder diagnosis. Pers Ment Health 2018; 12(1): 82-6.
[http://dx.doi.org/10.1002/pmh.1408] [PMID: 29226598]
]. This has resulted in many patients being undiagnosed, receiving multiple Personality Disorder (PD) diagnoses, or, most commonly, diagnosed with a PD not otherwise specified [4American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders 2000.].

A reflection of this was the inclusion of the Alternative DSM-5 Model for Personality Disorders (AMPD) in Section III of the DSM-5 [5American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders 2013.] 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 [5American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders 2013.] mal-adaptive traits is provided by The Personality Inventory for the DSM-5 (PID-5) [6Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med 2012; 42(9): 1879-90.
[http://dx.doi.org/10.1017/S0033291711002674] [PMID: 22153017]
], 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 [7Al-Dajani N, Gralnick TM, Bagby RM. A psychometric review of the Personality Inventory for DSM-5 (PID-5): Current status and future directions. J Pers Assess 2016; 98(1): 62-81.
[http://dx.doi.org/10.1080/00223891.2015.1107572] [PMID: 26619968]
], and with the ability to capture individual differences that were stable during four weeks up to four months intervals [8Pires R, Sousa Ferreira A, Guedes D. The psychometric properties of the Portuguese version of the Personality Inventory for DSM-5. Scand J Psychol 2017; 58(5): 468-75.
[http://dx.doi.org/10.1111/sjop.12383] [PMID: 28833245]
, 9Zimmermann J, Mayer A, Leising D, Krieger T, Holtforth MG, Pretsch J. Exploring occasion specificity in the assessment of DSM-5 maladaptive personality traits. A latent state-trait analysis. Eur J Psychol Assess 2017; 33: 47-54.
[http://dx.doi.org/10.1027/1015-5759/a000271]
]. 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 [10Somma A, Krueger RF, Markon KE, Fossati A. The replicability of the personality inventory for DSM-5 domain scale factor structure in U.S. and non-U.S. samples: A quantitative review of the published literature. Psychol Assess 2019; 31(7): 861-77.
[http://dx.doi.org/10.1037/pas0000711] [PMID: 30883152]
]. 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 [11Watters CA, Sellbom M, Bagby RM. Comparing two domain scoring methods for the Personality Inventory for DSM-5. Psychol Assess 2019; 31(9): 1125-34.
[http://dx.doi.org/10.1037/pas0000739] [PMID: 31233325]
].

The PID-5 facets and domains had conceptually and meaningfully converged with other established measures of personality and personality pathology [12Hopwood CJ, Wright AGC, Krueger RF, Schade N, Markon KE, Morey LC. DSM-5 pathological personality traits and the personality assessment inventory. Assessment 2013; 20(3): 269-85.
[http://dx.doi.org/10.1177/1073191113486286] [PMID: 23610235]
-15Van den Broeck J, Bastiaansen L, Rossi G, Dierckx E, De Clercq B, Hofmans J. Hierarchical structure of maladaptive personality traits in older adults: joint factor analysis of the PID-5 and the DAPP-BQ. J Pers Disord 2014; 28(2): 198-211.
[http://dx.doi.org/10.1521/pedi_2013_27_114] [PMID: 23786271]
], including The Personality Inventory for the ICD-11 [16Oltmanns JR, Widiger TA. A self-report measure for the ICD-11 dimensional trait model proposal: The personality inventory for ICD-11. Psychol Assess 2018; 30(2): 154-69.
[http://dx.doi.org/10.1037/pas0000459] [PMID: 28230410]
]. 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 [17DeYoung CG, Carey BE, Krueger RF, Ross SR. Ten aspects of the big five in the personality inventory for dsm-5. Pers Disord 2016; 7(2): 113-23.
[http://dx.doi.org/10.1037/per0000170] [PMID: 27032017]
, 18Helle AC, Trull TJ, Widiger TA, Mullins-Sweatt SN. Utilizing interview and self-report assessment of the Five-Factor Model to examine convergence with the alternative model for personality disorders. Pers Disord 2017; 8(3): 247-54.
[http://dx.doi.org/10.1037/per0000174] [PMID: 26986962]
], 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 [19Sleep CE, Hyatt CS, Lamkin J, Maples-Keller JL, Miller JD. Examining the relations among the DSM-5 alternative model of personality, the five-factor model, and externalizing and internalizing behavior. Pers Disord 2018; 9(4): 379-84.
[http://dx.doi.org/10.1037/per0000240] [PMID: 28125251]
].

Additionally, the PID-5 has proven its ability to capture the DSM-5 Section II PDs categories and symptoms [20Bach B, Sellbom M, Skjernov M, Simonsen E. ICD-11 and DSM-5 personality trait domains capture categorical personality disorders: Finding a common ground. Aust N Z J Psychiatry 2018; 52(5): 425-34.
[http://dx.doi.org/10.1177/0004867417727867] [PMID: 28835108]
], and other studies claimed its utility for treatment planning [21Morey LC, Benson KT. Relating DSM-5 section II and section III personality disorder diagnostic classification systems to treatment planning. Compr Psychiatry 2016; 68: 48-55.
[http://dx.doi.org/10.1016/j.comppsych.2016.03.010] [PMID: 27234182]
], as well as predicting psychosocial impairment [22Simms LJ, Calabrese WR. Incremental validity of the dsm-5 section iii personality disorder traits with respect to psychosocial impairment. J Pers Disord 2016; 30(1): 95-111.
[http://dx.doi.org/10.1521/pedi_2015_29_185] [PMID: 25905731]
].

The PID-5 has been translated into different languages and cultures and can be found in Arabic [23Al-Attiyah AA, Megreya AM, Alrashidi M, Dominguez-Lara SA, Al-Sheerawi AA. The psychometric properties of an Arabic version of the Personality Inventory for DSM-5 (PID-5) across three Arabic-speaking Middle Eastern countries. Int J Cult Ment Health 2017; 10(2): 197-05.
[http://dx.doi.org/10.1080/17542863.2017.1290125]
], Czech [24Riegel KD, Ksinan AJ, Samankova D, Preiss M, Harsa P, Krueger RF. Unidimensionality of the Personality Inventory for DSM-5 facets: Evidence from two Czech-speaking samples. Pers Ment Health
[http://dx.doi.org/10.1002/pmh.1423]
], Danish [25Bach B, Maples-Keller JL, Bo S, Simonsen E. The alternative DSM-5 personality disorder traits criterion: A comparative examination of three self-report forms in a Danish population. Pers Disord 2016; 7(2): 124-35.
[http://dx.doi.org/10.1037/per0000162] [PMID: 26642229]
], Dutch [26Bastiaens T, Claes L, Smits D, et al. The construct validity of the dutch personality inventory for dsm-5 personality disorders (pid-5) in a clinical sample. Assessment 2016; 23(1): 42-51.
[http://dx.doi.org/10.1177/1073191115575069] [PMID: 25736039]
], French [27Roskam I, Galdiolo S, Hansenne M, Massoudi K. Rossier Jr, Gicquel L, Rolland JP. The psychometric properties of the French version of the Personality Inventory for DSM-5. PLoS One 2015; 10: 1-13.
[http://dx.doi.org/10.1371/journal.pone.0133413]
], German [28Zimmermann J, Altenstein D, Krieger T, et al. The structure and correlates of self-reported DSM-5 maladaptive personality traits: findings from two German-speaking samples. J Pers Disord 2014; 28(4): 518-40.
[http://dx.doi.org/10.1521/pedi_2014_28_130] [PMID: 24511899]
], Indonesian [29Adhiatma W, Pinaima R, Siregal LB, Nova P, Kencana K, Halim MS, et al. Exploratory Factor Analysis for Indonesian version of PID-5. Indo Psychol Journal 2014; 29(4): 199-06.], Italian [30Fossati A, Krueger RF, Markon KE, Borroni S, Maffei C. Reliability and validity of the personality inventory for DSM-5 (PID-5): predicting DSM-IV personality disorders and psychopathy in community-dwelling Italian adults. Assessment 2013; 20(6): 689-708.
[http://dx.doi.org/10.1177/1073191113504984] [PMID: 24065702]
], Norwegian [31Thimm JC, Jordan S, Bach B. The Personality Inventory for DSM-5 Short Form (PID-5-SF): psychometric properties and association with big five traits and pathological beliefs in a Norwegian population. BMC Psychol 2016; 4(1): 61.
[http://dx.doi.org/10.1186/s40359-016-0169-5] [PMID: 27927237]
], Persian [32Soraya S, Kamalzadeh L, Nayeri V, Bayat E, Alavi K, Shariat SV. Factor Structure of Personality Inventory for DSM-5 (PID-5) in an Iranian Sample. Iranian J Psychi Clin Psychol 2017; 22(4): 308-17.
[http://dx.doi.org/10.18869/nirp.ijpcp.22.4.308]
], Polish [33Rowiński T, Kowalska-Dąbrowska M, Strus W, et al. Measurement of pathological personality traits according to the DSM-5: A Polish adaptation of the PID-5. Part II - empirical results. Psychiatr Pol 2019; 53(1): 23-48.
[http://dx.doi.org/10.12740/PP/OnlineFirst/86478] [PMID: 31008463]
], Portuguese [8Pires R, Sousa Ferreira A, Guedes D. The psychometric properties of the Portuguese version of the Personality Inventory for DSM-5. Scand J Psychol 2017; 58(5): 468-75.
[http://dx.doi.org/10.1111/sjop.12383] [PMID: 28833245]
], Brazilian-Portuguese [34Barchi-Ferreira AM, Loureiro SR, Torres AR, et al. Personality Inventory for DSM-5 (PID-5): cross-cultural adaptation and content validity in the Brazilian context. Trends Psychiatry Psychother 2019; 41(3): 297-300.
[http://dx.doi.org/10.1590/2237-6089-2018-0098] [PMID: 31166566]
], Russian [35Lozovanu S, Moldovanu I, Vovc V, Ganenco A, Blajevschi A, Besleaga T. Translation and validation of the Russian version of the personality inventory for DSM-5 (PID-5). Moldovan Med Jour 2019; 62: 3-6.], Spanish [36Gutiérrez F, Aluja A, Peri JM, et al. Psychometric properties of the spanish pid-5 in a clinical and a community sample. Assessment 2017; 24(3): 326-36.
[http://dx.doi.org/10.1177/1073191115606518] [PMID: 26391204]
], and Swedish [37Kajoniu PJ. The short personality inventory for dsm-5 and its conjoined structure with the common five-factor model. Int J Test 2017; 17: 372-84.
[http://dx.doi.org/10.1080/15305058.2017.1309421]
].

The translation study of the Arabic PID-5 [23Al-Attiyah AA, Megreya AM, Alrashidi M, Dominguez-Lara SA, Al-Sheerawi AA. The psychometric properties of an Arabic version of the Personality Inventory for DSM-5 (PID-5) across three Arabic-speaking Middle Eastern countries. Int J Cult Ment Health 2017; 10(2): 197-05.
[http://dx.doi.org/10.1080/17542863.2017.1290125]
] 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 [38Al-Tamimi FY. Assessment of language development Arabic encyclopedia of language and literacy development 2011., 39Ryding KC. A reference grammar of modern standard Arabic 2005.
[http://dx.doi.org/10.1017/CBO9780511486975]
]. However, the Arabic language is a diglossic language [40Ibrahim Z. Lexical variation: Modern Standard Arabic. Ency of Arabic Lang and Lingui 2008; 3: 13-21., 41Zeinoun P, Daouk-Öyry L, Choueiri L, van de Vijver FJR. A mixed-methods study of personality conceptions in the Levant: Jordan, Lebanon, Syria, and the West Bank. J Pers Soc Psychol 2017; 113(3): 453-65.
[http://dx.doi.org/10.1037/pspp0000148] [PMID: 28594200]
] 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 [40Ibrahim Z. Lexical variation: Modern Standard Arabic. Ency of Arabic Lang and Lingui 2008; 3: 13-21., 41Zeinoun P, Daouk-Öyry L, Choueiri L, van de Vijver FJR. A mixed-methods study of personality conceptions in the Levant: Jordan, Lebanon, Syria, and the West Bank. J Pers Soc Psychol 2017; 113(3): 453-65.
[http://dx.doi.org/10.1037/pspp0000148] [PMID: 28594200]
]. 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 [42Zeinoun P, Daouk-Öyry L, Choueiri L, Van de Vijver F. Arab Levantine Personality: A psycholexical study in Lebanon, Syria, Jordan and the West Bank. J Pers 2018; 86(3): 397-21.
[http://dx.doi.org/10.1111/jopy.12324] [PMID: 28509383]
], which is related with Fantasy, Aesthetics, Feelings, Actions, Ideas, and Values [43McCrae RR. Exploring trait assessment of samples, persons, and cultures. J Pers Assess 2013; 95(6): 556-70.
[http://dx.doi.org/10.1080/00223891.2013.821075] [PMID: 23924211]
]. 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 [23Al-Attiyah AA, Megreya AM, Alrashidi M, Dominguez-Lara SA, Al-Sheerawi AA. The psychometric properties of an Arabic version of the Personality Inventory for DSM-5 (PID-5) across three Arabic-speaking Middle Eastern countries. Int J Cult Ment Health 2017; 10(2): 197-05.
[http://dx.doi.org/10.1080/17542863.2017.1290125]
], 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 [23Al-Attiyah AA, Megreya AM, Alrashidi M, Dominguez-Lara SA, Al-Sheerawi AA. The psychometric properties of an Arabic version of the Personality Inventory for DSM-5 (PID-5) across three Arabic-speaking Middle Eastern countries. Int J Cult Ment Health 2017; 10(2): 197-05.
[http://dx.doi.org/10.1080/17542863.2017.1290125]
], 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 [23Al-Attiyah AA, Megreya AM, Alrashidi M, Dominguez-Lara SA, Al-Sheerawi AA. The psychometric properties of an Arabic version of the Personality Inventory for DSM-5 (PID-5) across three Arabic-speaking Middle Eastern countries. Int J Cult Ment Health 2017; 10(2): 197-05.
[http://dx.doi.org/10.1080/17542863.2017.1290125]
], (c) to explore the association between the PID-5 domains with the FFM, measured by the Arabic NEO – Five Factor Inventory (NEO-FFI), [4American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders 2000., 5American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders 2013.] and (d) to examine the PID-5’s factor structure in the Emirati community sample.

2. METHODS

2.1. Sample

The participants were a total of 1,090 volunteers aged between 18 and 57 years old (M = 22.44, SD = 6.63, 89.5% female, 10.5% male) recruited from Zayed University students and their acquaintances. Test-retest reliability was studied with a sample of 28 students, 85.7% females, 14.3% males, Mage= 28.6, SD = 9.64. The inclusion criteria were Emirati native Arabic speakers aged 18 years old and above who have completed primary school or higher.

2.2. Procedures

Participation in this study was voluntary and all respondents signed a written informed consent form requesting their participation in the study, the possibility of giving up at any time, and that the data would be used exclusively in a scientific study. The experimental sessions were held collectively and conducted at Zayed University after obtaining approval from the Research Ethics Committee of Zayed University. In the temporal stability study, the interval between the 1st and the 2nd application was four weeks and data was matched through a code given to the participants in the first session.

2.3. Measures

The Personality Inventory for the DSM-5 (Krueger et al [6Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med 2012; 42(9): 1879-90.
[http://dx.doi.org/10.1017/S0033291711002674] [PMID: 22153017]
], Arabic version by Al-Attiyah et al. [23Al-Attiyah AA, Megreya AM, Alrashidi M, Dominguez-Lara SA, Al-Sheerawi AA. The psychometric properties of an Arabic version of the Personality Inventory for DSM-5 (PID-5) across three Arabic-speaking Middle Eastern countries. Int J Cult Ment Health 2017; 10(2): 197-05.
[http://dx.doi.org/10.1080/17542863.2017.1290125]
])

The PID-5 is a self-report measure composed of 220 items, rated on a four-point Likert scale ranging from 0 (very false or often false) to 3 (very true or often true), that characterizes 25 empirically derived lower level facets grouped into five major domains of mal-adaptive personality variation. Data from the Al-Attiyah et al. [23Al-Attiyah AA, Megreya AM, Alrashidi M, Dominguez-Lara SA, Al-Sheerawi AA. The psychometric properties of an Arabic version of the Personality Inventory for DSM-5 (PID-5) across three Arabic-speaking Middle Eastern countries. Int J Cult Ment Health 2017; 10(2): 197-05.
[http://dx.doi.org/10.1080/17542863.2017.1290125]
] study showed that the Cronbach’s alphas of the PID-5 scales were moderate to high, ranging from .70 (Manipulativeness) to .93 (Attention seeking) at the facet level, and .92 (Antagonism) to .96 (Detachment) at the domain level.

NEO-Five Factor Inventory (NEO-FFI, Costa & McCrae [44Alansari BM. The psychometric Properties of NEO Five – factor Inventory (NEO-FFI-S) based on the Kuwaiti Society. Psychol Quarterly 1997; 7: 277-10.], Arabic version by Alansari [45Costa PTJr, McCrae RR. Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual.Psychological Assessment Resources 1992.])

The NEO-FFI is a measure of the five basic personality factors (Neuroticism, Extraversion, Openness to Experiences, Agreeableness, and Conscientiousness) composed by 60 items rated on a five-point Likert response format, ranging from 0 (strongly disagree) to 4 (strongly agree). The Arabic version of the NEO-FFI [45Costa PTJr, McCrae RR. Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual.Psychological Assessment Resources 1992.] was used, and to prevent validity issues and ensure conceptual equivalence of the measure, a preliminary study was conducted in the Emirati population. Results confirmed a five-factor structure supporting the universality of the FFM. Cronbach’s alphas ranged from acceptable .65 (Openness) to high .85 (Neuroticism), in line with the results reported in the US sample, which ranged from .68 to .86 [44Alansari BM. The psychometric Properties of NEO Five – factor Inventory (NEO-FFI-S) based on the Kuwaiti Society. Psychol Quarterly 1997; 7: 277-10.].

2.4. Data Analysis

Analysis was conducted with the IBM SPSS Statistics (v.25, SPSS Inc., Chicago, IL). Cohen’s d was used as a measure of effect size, in order to study the mean score differences between the Emirati and the original sample [6Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med 2012; 42(9): 1879-90.
[http://dx.doi.org/10.1017/S0033291711002674] [PMID: 22153017]
].The effect size was considered small when d ≤ .20, medium when .20 < d ≤ .50, large when .50 < d ≤ 1.0, and very large when d > 1.0. The internal consistency was measured by Cronbach’s alpha, while test-retest and convergent validity analyses were conducted by the Pearson coefficient, or Spearman’s rank coefficient if the dataset did not follow a normal distribution. Due to the complexity of the personality structure, in which traits present several cross-loadings, the PID-5 structure in the United Arab Emirates national population was examined through exploratory factor analyses (EFA), using Equamax oblique rotation, and the number of factors to be extracted and interpreted was based on the Kaiser’s, Velicer’s minimum average partial test (MAP), and Parallel Analysis criteria.

3. RESULTS

3.1. Descriptive Statistics

Descriptive statistics for the five domains and 25 facets were compared with the data from the original study [6Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med 2012; 42(9): 1879-90.
[http://dx.doi.org/10.1017/S0033291711002674] [PMID: 22153017]
] through Cohen’s d (Table 1). Small to medium effect sizes would reveal greater similarities between the original study and the Emiratis’ response style. The domains Negative affectivity, Detachment, and Disinhibition showed medium effect sizes (≤ .50), and large effect sizes were obtained for Psychoticism (.60) and Antagonism (.95). At the facets level, medium effect sizes (.20 - .50) were found for 13 of the facets, with nine facets showing large effect sizes (> .50).The smaller effect sizes (≤ .20) were found on Anhedonia, Rigid perfectionism, and Withdrawal, while the larger effect sizes (≥ .80) were displayed in Cognitive and Perceptual dysregulation and Irresponsibility.

Table 1
Internal consistencies (α), means (M), standard deviations (SD), and Cohen’s d between the three studies for the 25 facets and five domains.


3.2. Reliability

The internal consistency of the Arabic PID-5 scales in the Emirati sample showed moderate (≥ .70 for 13 of the 25 facets) to high (≥ .80 for 11 of the 25 facets) coefficients, with a mean alpha of 0.74 (Table 1). One facet showed a poor reliability coefficient of .37 (Suspiciousness). At the domain level, the alphas ranged from .81 (Antagonism) to .92 (Psychoticism) with a mean of .86. These results showed that the majority of the facets and the five domains were reliable, although with coefficients slightly lower than the ones previously found with other Arabic-speaking samples [23Al-Attiyah AA, Megreya AM, Alrashidi M, Dominguez-Lara SA, Al-Sheerawi AA. The psychometric properties of an Arabic version of the Personality Inventory for DSM-5 (PID-5) across three Arabic-speaking Middle Eastern countries. Int J Cult Ment Health 2017; 10(2): 197-05.
[http://dx.doi.org/10.1080/17542863.2017.1290125]
] and in the original study [6Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med 2012; 42(9): 1879-90.
[http://dx.doi.org/10.1017/S0033291711002674] [PMID: 22153017]
].

3.3. Test-retest Reliability

The results of the test-retest reliability are displayed in Table 2. At the domain level, the correlation coefficients values ranged from .79 (p < .01) for Detachment to .92 (p <.01) for the Antagonism domain. At the facets level, the correlation coefficients values were higher than ≥ .80 for 19 of the 25 facets, ranging from .73 (p < .01) for Restricted affectivity to .94 (p < .01) for the Attention seeking scale.

Table 2
Stability coefficients of the Arabic version of the PID-5 facets and domains in the UAE sample.


3.4. Convergent Validity

The convergent validity of the Arabic PID-5 in the Emirati sample was investigated by correlating the five domains of the PID-5 with the five factors of NEO-FFI (Table 3). As expected, the domain Negative affectivity correlated moderate and positively with Neuroticism (r = .57, p < .01), Detachment correlated moderate and negatively with Extraversion (r = -.49, p < .01) as well as Antagonism with Agreeableness (r = -.36, p < .01), and Disinhibition with Conscientiousness (r = -.50, p < .01). The domain Psychoticism displayed a low positive relationship with the factor Openness to Experience (r = .24, p < .01).

3.5. Structure of the PID-5

The structure of the Arabic PID-5 in the Emirati community sample was tested through EFA of the 25 facets and the Kaiser, MAP, and Parallel analysis criteria were considered to evaluate the number of factors to be extracted and interpreted. A five-factor solution was supported by the Kaiser and Parallel analysis. The model showed excellent fit indices (KMO=.906), with a total explained variance of 61.21%. Communalities showed that the percentage of variance explained by the extracted factors was above 50% for all but four facets (Hostility, Risk taking, Submissiveness, and Suspiciousness), as can be seen in Table 4.

Table 3
Correlations r of the Arabic version of the PID-5 with the NEO-FFI in the UAE sample.


Table 4
Exploratory factor analysis with Equamax rotation solution in an UAE community sample.


Factor 1 was composed of the facets Anxiousness, Emotional lability, Hostility, Perseveration, Separation insecurity, Submissiveness, and Suspiciousness and matched the Negative affectivity domain structure.

Factor 2 was similar to Detachment and was composed of Anhedonia, Depressivity, Intimacy avoidance, Restricted affectivity, and Withdrawal. The only exception was the facet Suspiciousness, which loaded onto Factor 1. However, according to the DSM-5 personality model, this facet together with Depressivity and Restricted affectivity, simultaneously characterizes the domains Negative affectivity and Detachment.

The third Factor aggregated the facets Distractibility, Impulsivity, and Risk taking and resembled the Disinhibition domain, with the majority of the domain facets loaded. The only exception was the facet Irresponsibility that loaded primarily in the fourth Factor (.43) but had its secondary load in (.43) Factor three.

The fourth Factor mirrored the Antagonism domain, with all the facets of the domain primarily loaded in this factor. The exception was the facet Grandiosity (a facet of Antagonism), which unexpectedly also loaded primarily in Factor five.

Finally, the factor that most deviated from the personality domain structure of the AMPD [5American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders 2013.], was the fifth one, onto the facets Grandiosity, Rigid perfectionism, and Unusual beliefs and experiences mainly weighted. However, both the facets Cognitive and perceptual dysregulation and Eccentricity (≥ .30) loaded on a second level in this factor, which might suggest that the fifth Factor is similar to the Psychoticism domain.

Ultimately, the Arabic PID-5 in the Emirati population revealed a five-factor solution similar to the DSM-5 AMPD [5American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders 2013.], although not entirely overlapped. Moreover, the internal consistency of the new factors was calculated based on all the facets loaded onto each factor. The mean reliability coefficient varied from 0.81 for the first Factor (Negative affectivity) to 0.68 for the fifth Factor (Psychoticism), being this last factor the outlier of the original structure and consequently less interpretable. Although the three facets are considered loaded in the fifth Factor in conjunction with the other two facets of Psychoticism, namely the Cognitive and perceptual dysregulation and Eccentricity (loaded secondarily onto it), an alpha of .75 is obtained.

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 [6Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med 2012; 42(9): 1879-90.
[http://dx.doi.org/10.1017/S0033291711002674] [PMID: 22153017]
], 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 [23Al-Attiyah AA, Megreya AM, Alrashidi M, Dominguez-Lara SA, Al-Sheerawi AA. The psychometric properties of an Arabic version of the Personality Inventory for DSM-5 (PID-5) across three Arabic-speaking Middle Eastern countries. Int J Cult Ment Health 2017; 10(2): 197-05.
[http://dx.doi.org/10.1080/17542863.2017.1290125]
]. 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 [43McCrae RR. Exploring trait assessment of samples, persons, and cultures. J Pers Assess 2013; 95(6): 556-70.
[http://dx.doi.org/10.1080/00223891.2013.821075] [PMID: 23924211]
, 46Van de Vijver FJR, Leung K. Methods and data analysis of comparative research. In Handbook of cross-cultural psychology: Theory and method 1997; 257-300.]. 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 [7Al-Dajani N, Gralnick TM, Bagby RM. A psychometric review of the Personality Inventory for DSM-5 (PID-5): Current status and future directions. J Pers Assess 2016; 98(1): 62-81.
[http://dx.doi.org/10.1080/00223891.2015.1107572] [PMID: 26619968]
]).

As expected, the five domains of the Arabic PID-5 displayed meaningful associations with the five domains of the Arabic NEO-FFI [23Al-Attiyah AA, Megreya AM, Alrashidi M, Dominguez-Lara SA, Al-Sheerawi AA. The psychometric properties of an Arabic version of the Personality Inventory for DSM-5 (PID-5) across three Arabic-speaking Middle Eastern countries. Int J Cult Ment Health 2017; 10(2): 197-05.
[http://dx.doi.org/10.1080/17542863.2017.1290125]
, 47De Fruyt F, De Clercq B, De Bolle M, Wille B, Markon K, Krueger RF. General and maladaptive traits in a five-factor framework for DSM-5 in a five-factor framework for DSM-5 in a university student sample. Assessment 2013; 20(3): 295-307.
[http://dx.doi.org/10.1177/1073191113475808] [PMID: 23405016]
, 48Few LR, Miller JD, Rothbaum AO, et al. Examination of the Section III DSM-5 diagnostic system for personality disorders in an outpatient clinical sample. J Abnorm Psychol 2013; 122(4): 1057-69.
[http://dx.doi.org/10.1037/a0034878] [PMID: 24364607]
]. Nonetheless the positive relationship between Psychoticism and Openness to experience was rather small [14Crego C, Oltmanns JR, Widiger TA. FFMPD scales: Comparisons with the FFM, PID-5, and CAT-PD-SF. Psychol Assess 2018; 30(1): 62-73.
[http://dx.doi.org/10.1037/pas0000495] [PMID: 29323514]
, 49Thomas KM, Yalch MM, Krueger RF, Wright AGC, Markon KE, Hopwood CJ. The convergent structure of DSM-5 personality trait facets and five-factor model trait domains. Assessment 2013; 20(3): 308-11.
[http://dx.doi.org/10.1177/1073191112457589] [PMID: 22946103]
], 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 [50Widiger TA, Crego C. HiTOP thought disorder, DSM-5 psychoticism, and five factor model openness. J Res Pers 2019; 80: 72-7.
[http://dx.doi.org/10.1016/j.jrp.2019.04.008]
].

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. [6Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med 2012; 42(9): 1879-90.
[http://dx.doi.org/10.1017/S0033291711002674] [PMID: 22153017]
] and by Al-Attiyah et al. [23Al-Attiyah AA, Megreya AM, Alrashidi M, Dominguez-Lara SA, Al-Sheerawi AA. The psychometric properties of an Arabic version of the Personality Inventory for DSM-5 (PID-5) across three Arabic-speaking Middle Eastern countries. Int J Cult Ment Health 2017; 10(2): 197-05.
[http://dx.doi.org/10.1080/17542863.2017.1290125]
]. 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 [5American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders 2013.]. 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 [51Hopwood CJ, Schade N, Krueger RF, Wright AGC. MarkonKE. Connecting DSM-5 Personality Traits and Pathological Beliefs: Toward a Unifying Model. JPsychopa. Behav Assess 2013; 35(2): 162-72.]. In this regard, some studies have found evidence for an association between some features of Obsessive-Compulsive PD with Schizotypal PD [52Chmielewski M, Watson D. The heterogeneous structure of schizotypal personality disorder: item-level factors of the Schizotypal Personality Questionnaire and their associations with obsessive-compulsive disorder symptoms, dissociative tendencies, and normal personality. J Abnorm Psychol 2008; 117(2): 364-76.
[http://dx.doi.org/10.1037/0021-843X.117.2.364] [PMID: 18489212]
]. In fact, although the domain Psychoticism primarily emerged from features of Negative affectivity, Disinhibition, and Detachment [53Wright AGC, Thomas KM, Hopwood CJ, Markon KE, Pincus AL, Krueger RF. The hierarchical structure of DSM-5 pathological personality traits. J Abnorm Psychol 2012; 121(4): 951-7.
[http://dx.doi.org/10.1037/a0027669] [PMID: 22448740]
, 54Bo S, Bach B, Mortensen EL, Simonsen E. Reliability and hierarchical structure of dsm-5 pathological traits in a danish mixed sample. J Pers Disord 2016; 30(1): 112-29.
[http://dx.doi.org/10.1521/pedi_2015_29_187] [PMID: 25905735]
], it has been pointed as heterogeneous, and some studies found deviant facet loading in this domain [29Adhiatma W, Pinaima R, Siregal LB, Nova P, Kencana K, Halim MS, et al. Exploratory Factor Analysis for Indonesian version of PID-5. Indo Psychol Journal 2014; 29(4): 199-06., 55Bach B, Sellbom M, Simonsen E. Personality inventory for dsm-5 (pid-5) in clinical versus nonclinical individuals: generalizability of psychometric features. Assessment 2018; 25(7): 815-25.
[http://dx.doi.org/10.1177/1073191117709070] [PMID: 28503935]
]. Others even reported its absence from their factor structure in a clinical sample [56Pires R, Sousa Ferreira A, Gonçalves B, Henriques-Calado J, Paulino M. The portuguese version of the personality inventory for the dsm-5 in a community and a clinical sample. Pers Ment Health 2019; 13(1): 40-52.
[http://dx.doi.org/10.1002/pmh.1437] [PMID: 30456905]
]. 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 [57Bach B, Sellbom M, Kongerslev M, Simonsen E, Krueger RF, Mulder R. Deriving ICD-11 personality disorder domains from dsm-5 traits: initial attempt to harmonize two diagnostic systems. Acta Psychiatr Scand 2017; 136(1): 108-17.
[http://dx.doi.org/10.1111/acps.12748] [PMID: 28504853]
, 58Lotfi M, Bach B, Amini M, Simonsen E. Structure of DSM-5 and ICD-11 personality domains in Iranian community sample. Pers Ment Health 2018; 12(2): 155-69.
[http://dx.doi.org/10.1002/pmh.1409] [PMID: 29392855]
]. 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 [59Skodol AE, Clark LA, Bender DS, Krueger RF, Morey LC, Verheul R. Proposed changes in personality and personality disorder assessment and diagnosis for dsm-5 part I: description and rationale. person disorders: . Theor Res Treat 2011; 1(2): 4-22.]. On this note, a recent study by Bastiaens et al. [60Bastiaens T, Smits D, De Hert M, et al. The Relationship Between the Personality Inventory for the DSM-5 (PID-5) and the Psychotic Disorder in a Clinical Sample. Assessment 2019; 26(2): 315-23.
[http://dx.doi.org/10.1177/1073191117693922] [PMID: 29214869]
], 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 [61Costa PT, Terracciano A, McCrae RR. Gender differences in personality traits across cultures: robust and surprising findings. J Pers Soc Psychol 2001; 81(2): 322-31.
[http://dx.doi.org/10.1037/0022-3514.81.2.322] [PMID: 11519935]
, 62Weisberg YJ, Deyoung CG, Hirsh JB. Gender differences in personality across the ten aspects of the big five. Front Psychol 2011; 2(2): 178.
[http://dx.doi.org/10.3389/fpsyg.2011.00178] [PMID: 21866227]
] and that gender roles and expectations tend to be more clearly demarcated in Arabic cultures when compared to Western cultures [63Al-KrenawiA. A Study of psychological symptoms, family function, marital and life satisfaction of polygamous and monogamous women: The Palestinian case. IntJSocPsych 2012; 58(1): 79-86.]. 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 1st and the 2nd 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 [5American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders 2013.] to other Arab countries.

LIST OF ABBREVIATIONS

AMPD  = Alternative DSM-5 Model for personality Disorders
APA  = American Psychiatric Association
d  =  Cohen’s d
EFA  = Exploratory Factor analyses
DSM-5  = Diagnostic and Statistical Manual of Mental disorders - 5th Edition
FFM  = Five Factor Model
IBM SPSS statistics  = IBM Statistical Package for Social Sciences
ICD-11  = International Classification of Mental and Behavioural Disorders – 11th Edition
KMO  = Kaiser-Meyer-Olkin test of sampling adequacy
M  = Media
MAP  =  Velicer’s minimum average partial test
MSA  = Modern Standard Arabic
N  = number of participants
NEO  = FFI – NEO Five Factor Inventory
p  = Value of significance
PDs  = Personality Disorders
PD  = Personality Disorder
PID-5  = Personality Inventory for DSM-5
r  = Pearson coefficient
rs  = Spearman’s rank coefficient
SD  = Standard deviation
UAE  = United Arab Emirates
WHO  = World Health Organization
α  = Cronbach alpha

ETHICS APPROVAL & CONSENT TO PARTICIPATE

The experimental sessions were held collectively and conducted at Zayed University after obtaining approval from the Research Ethics Committee of Zayed University, UAE.

HUMAN AND ANIMAL RIGHTS

Not applicable.

CONSENT FOR PUBLICATION

Participation in this study was voluntary and all respondents signed a written informed consent form requesting their participation in the study.

AVAILABILITY OF DATA AND MATERIALS

The data that support the findings of this study are available from the corresponding author [O.C.] upon reasonable request.

FUNDING

None.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

We would like to thank all the volunteer students and staff from Zayed University Dubai and Abu Dhabi that collaborated on this research.

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