Empirical Typology

Journal of Adolescence 66 (2018) 31–48
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Journal of Adolescence
journal homepage: www.elsevier.com/locate/adolescence
Empirical typology of adolescent personality organization

T
a,∗ b b c
Marko Biberdzic , Karin Ensink , Lina Normandin , John F. Clarkin
a
School of Psychology, University of Wollongong, NSW, Australia
b
École de psychologie, Université Laval, Québec, Canada
c
Department of Psychiatry, Weill Cornell Medical College, NY, USA
ABS TRA CT
The concept of personality organization (PO) is central to current psychodynamic understanding

of normal personality development as well as the development of personality disorders (PDs).
However, individual differences in PO have primarily been studied in adult populations, and it
remains unclear whether the clinical indicators of normal, neurotic and borderline PO manifest
differently during adolescence. This study aimed to address the gaps in current knowledge re-
garding the potentially different manifestation of pathological PO in adolescence. In addition, we
wanted to further establish the validity of the adolescent version of the Inventory of Personality
Organization, by identifying cut-off points for each of the main dimensions of Normal, Neurotic,
and Borderline PO. Participants included 430 adolescents (M = 16 years old) from the com-
munity. Cluster analysis identified three levels of PO corresponding to Normal, Neurotic, and
Borderline PO. Cut- off points between the different POs were successfully established using ROC
curve analyses.
Adolescence is known as a period of rapid change, as well as a crucial period for identity development and personality con-
solidation (Blos, 1968; Erikson, 1968). It is also a period in which emerging pathological personality features and processes can be
identified (Kobak, Zajac, & Smith, 2009). Over the last decade, it has become increasingly clear that personality disorders (PDs) do
occur in adolescents, and there is growing support for early intervention given the severe consequences in terms of functioning and
personal suffering associated with these disorders (De Fruyt & De Clercq, 2014; Gunderson, 2009; Miller, Muehlenkamp, & Jacobson,
2008). However, despite similar prevalence rates of PDs in adolescence and adulthood, there is evidence that both normal and
pathological personality features may manifest differently in adolescence than in adulthood. For example, differences in personality
structure and underlying dimensions of personality (e.g. negative affectivity) have been reported between normal populations of
adolescents and adults (Ryan, 2009). With regard to PDs, and Borderline Personality Disorder (BPD) more specifically, findings
suggest that the underlying psychological mechanisms of BPD are different in adolescents than in adults (Chabrol et al., 2004), and
that the BPD diagnosis may represent a more diffuse range of psychopathology in adolescents than in adults (Becker, Grilo, Edell, &
McGlashan, 2000). There is also evidence that adolescent PDs, in general, possibly express themselves in a more severe way, con-
sidering that they are associated with more painful affects (Bradley, Zittel Conklin, & Westen, 2005), and with more self-destructive
and suicidal behavior (Goodman et al., 2017). These age-related differences in symptomatology and severity are understood as being
a product of the principle of heterotypic continuity (Kagan, 1969), according to which traits evolve in the context of development,
while having the same level of underlying personality pathology (Courtney-Seidler, Klein, & Miller, 2013). As a result of these
discrepancies, different personality types among adolescents and adults have also been investigated, in both normal (Costa, Herbst,
McCrae, Samuels, & Ozer, 2002) and clinical (Bradley et al., 2005) samples.
∗
Corresponding author.
E-mail address: marko_biberdzic@uow.edu.au (M. Biberdzic).
https://doi.org/10.1016/j.adolescence.2018.04.004
Received 19 September 2016; Received in revised form 23 April 2018; Accepted 25 April 2018
Available online 07 May 2018
0140-1971/ © 2018 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.
M. Biberdzic et al. Journal of Adolescence 66 (2018) 31–48
However, the bulk of the existing research on the typology and core features of both normal personality and personality pathology
in adolescence has been conducted either within the Five-factor model tradition or the categorical Diagnostic and Statistical Manual of
Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013) framework. Although both of these approaches have been
useful, a more integrative conceptualization of both normal and pathological personality has been recently called upon to inform
existing gaps in our understanding of adolescent personality (DeFife & Ritschel, 2013; Shiner & Allen, 2013). As Courtney-Seidler
et al. (2013) have pointed out, a dimensional approach that focuses on underlying personality functioning might be most appropriate
for a developmentally sensitive assessment of youth. One such model that allows both a categorical and a dimensional approach to
personality assessment is Kernberg's (1996) structural model of personality organization. We describe this model in the following
section, as well as the assessment tool potentially suited to measure adolescent personality organization. Considering the promising
results of the recently validated measure of adolescent personality organization, the Inventory of Personality Organization for
Adolescents (IPO-A; Biberdzic, Ensink, Normandin, Clarkin, & Kernberg, 2013), the aim of this study was to address the gaps in
current knowledge regarding the potentially different manifestation of pathological personality organization in adolescence, as well
as to further validate the IPO-A in order to potentially identify adolescents with specific difficulties related to personality functioning.
1. Personality organization
Over the years, Kernberg and colleagues (Kemberg, 1996; Kernberg & Caligor, 2005; Clarkin, Yeomans, & Kernberg, 2007;
Yeomans, Clarkin, & Kernberg, 2015) have elaborated a model of personality functioning and pathology that revolves around the
concept of personality organization (PO). PO refers to the relatively stable, mostly unconscious structure that dynamically organizes
mental processes and contents, enduring patterns of behavior, emotion, and ways of relating to others that are characteristic of an
individual (Gamache et al., 2009; Koelen et al., 2012). These dynamically organized and repetitively activated structures and pro-
cesses are assumed to be involved in motivation, the regulation of mood, affect, and impulses (Westen, Gabbard, & Blagov, 2006).
According to Kernberg (2015), the basic components of PO include temperament, character, identity, value systems, and cognitive
capability (intelligence). From a developmental perspective, PO is hypothesized to predominantly stem from the integration,
throughout childhood, of inner representations of early relationships with significant others, including the affective quality of these
relationships (Caligor, Kernberg, & Clarkin, 2007).
More specifically, according to Kernberg, as well as other pioneers of object relations theory (Fairbairn, 1954; Jacobson, 1964;
Klein, 1958; Mahler, Pine, & Bergman, 1975), “affects initiate the interactions between self and other, and the internalization of these
interactions, in the form of affective memory, determines the internalized models of behavior (in attachment terminology), or in-
ternalized object relations (in psychoanalytic object relations theory language). These internalized models, or object relations,
gradually determine integrated, reactive habitual behavior patterns that constitute character. The subjective organization of the
experience of self, as part of internalized object relations, gradually consolidates into an integrated concept of self, with a parallel
organization of the concept of significant others, in other words, normal identity” (Kernberg, 2012, 2015). In this model, the
achievement of an integrated identity is thus regarded not only as central for healthy personality development, but is also viewed as a
major developmental task in adolescence, with severe disintegration of identity being linked to the development of PDs, especially
borderline pathology. This viewpoint has recently also been adopted by the DSM, in which identity disturbance has been integrated
as a key criterion for diagnosing PDs in general (APA, 2013).
In recent years, the notion of PO has become a central construct in contemporary psychodynamic approaches to both normal and
disrupted personality development (Caligor & Clarkin, 2010; Fonagy & Luyten, 2012; Westen et al., 2006). In particular, the concept
of PO plays a key role in current psychodynamic understanding of the development of PDs (Caligor & Clarkin, 2010; Kernberg &
Caligor, 2005; McWilliams, 1994) and their treatment (Clarkin et al., 2007a,b,c).
However, since PO is a latent construct, it is inferred from manifest indicators that are characteristic of an individual, namely: (1)
their level of identity integration, (2) their level of predominantly used defenses (ranging from primitive defense mechanisms such as
splitting denial, and projective identification, to more mature defenses such as repression and rationalization), (3) the extent of their
reality testing (i.e. their capacity to differentiate self from non-self, intrapsychic from external stimuli), (4) their level of aggression
(toward self and others), and (5) the strength of their moral functioning (i.e. ethical behavior, ideals, and values; Caligor & Clarkin,
2010). Although these features are believed to define a continuum of personality pathology and functioning, four levels or types of PO
are proposed and distinguished for clinical purposes: Normal PO, Neurotic (NPO), Borderline (BPO), and Psychotic (PPO; Caligor &
Clarkin, 2010). Normal PO and NPO are both assumed to be characterized by relatively high levels of identity integration, pre-
dominant use of mature (i.e. higher level) defense mechanisms, intact reality testing, lower levels of aggression, and well integrated
moral functioning. However, individuals with normal personality are believed to reach higher levels on these dimensions, and exhibit
more flexibility (e.g., in the experience and expression of affective states, aggressive impulses, and in the development of an in-
ternalized moral values system) than individuals with NPO (Caligor & Clarkin, 2010). Individuals organized at a neurotic level are
believed to generally function well in many domains, with maladaptive personality traits typically interfering predominantly in focal
areas of functioning and/or causing subjective distress. This group includes individuals that present “higher-level” PDs, namely the
obsessive-compulsive and depressive PDs, and also the large group of patients seen in clinical practice who present with personality
pathology but not of sufficient severity to meet criteria for a DSM PD (Caligor & Clarkin, 2010; Westen & Arkowitz-Westen, 1998). On
the other end of the spectrum, BPO is assumed to be characterized by identity diffusion (i.e. a distorted and inconsistent view of self
and others), and the predominant use of primitive defense mechanisms with relatively intact reality testing. Higher levels of ag-
gression are also believed to be characteristic of individuals functioning at the BPO level, and pathology of moral functioning to be
more common in these individuals (Clarkin et al., 2007). In this group of individuals functioning at a borderline level of PO, we find
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most of the PDs described in the DSM, including the narcissistic, borderline, paranoid, and antisocial PDs. Lastly, PPO is hypothesized
to be also characterized by identity diffusion, the use of primitive defense mechanisms, marked impairment of reality testing, and
variable levels of aggression and moral impairment (Caligor & Clarkin, 2010).
Kernberg's theoretical assumptions and model of personality functioning have been the object of empirical scrutiny in recent
years, and the relationship between PO, psychopathology, and PDs more specifically has been empirically supported in both clinical
and non-clinical adult populations (Ellison & Levy, 2012; Ensink, Rousseau, Biberdzic, Bégin, & Normandin, 2017; Gagnon, Vintiloiu,
& McDuff, 2016; Pilarska & Suchańska, 2016; Sollberger & Walter, 2010; Stern et al., 2010; Yun, Stern, Lenzenweger, & Tiersky,
2013), with the construct of PO being used to measure structural aspects of personality functioning (Fischer-Kern et al., 2010; Koelen
et al., 2012). For example, in a clinical sample of patients with BPD, Sollberger and Walter (2010) found that BPD patients with high
identity diffusion showed significantly higher levels of psychiatric symptoms, as well as higher anxiety, anger, and depression scores
compared to BPD patients with lower identity diffusion. The former also suffered more frequently from concurrent PDs. These
findings suggest an association between PO and psychopathological symptoms and features of PDs, and emphasize the clinical
significance of the core dimensions of PO for understanding personality pathology. Although similar empirical evidence among
adolescent populations is scarce, the importance of assessing PO in youth has recently been supported, with results from a recent
study indicating (1) significantly lower levels of identity integration, (2) higher use of primitive defenses, (3) higher impairment of
reality testing, (4) higher levels of aggression, and (5) poorer moral functioning in a non-clinical sample of adolescents compared to a
non-clinical sample of young adults (Biberdzic, Ensink, Normandin, & Clarkin, 2017), hence suggesting potential differences between
these two populations with regard to the core dimensions of PO. However, it remains unknown whether these features, in adoles-
cents, are empirically related to the theorized levels of PO as reported in adults (Fischer-Kern et al., 2010), and whether these levels of
PO are associated with indicators of maladjustment and psychopathology in adolescents.
2. Assessing personality organization
Since PO is a multi-faceted latent construct that is challenging to assess comprehensively, a variety of assessment approaches of
PO have been developed. Along with the Structured Interview of PO (STIPO; Clarkin, Caligor, Stern, & Kernberg, 2004), Clarkin and
colleagues have developed the Inventory of Personality Organization (IPO; Clarkin, Kernberg, & Foelsch, 2001), a self-report in-
strument that has been demonstrated to have sound psychometric properties in both clinical and non-clinical adult populations (for a
review, see Blais, 2010). Since the IPO's development, it has been used in several studies to investigate the relationship between PO,
psychopathology, and personality dysfunction (Ellison & Levy, 2012). For example, research has shown that scores on the IPO
subscales (i.e. the five core dimensions of PO) distinguish between patients with BPD and those with a major depressive disorder
(Walter et al., 2009), and between individuals with a PD and those without (Kraus, Dammann, Rothgordt, & Berner, 2004). The IPO
has also shown theoretically convergent correlations with other problematic personality traits and psychiatric symptoms (Ellison &
Levy, 2012). For example, Pincus et al. (2009) found that IPO subscales were highly correlated with pathological narcissism in a non-
clinical undergraduate sample. Moreover, Vermote et al. (2009) reported relations between the IPO dimensions and self-harm,
anxiety, depression, and anger. More recently, Yun et al. (2013) used the IPO as an external validity measure for a PD taxonomy
based on paranoid, aggressive, and antisocial features. The IPO has also been used as an outcome measure in randomized controlled
trials of PD treatment (Arntz & Bernstein, 2006; Giesen-Bloo et al., 2006).
With regard to the adolescent population, an adapted version of the IPO (IPO-A; Biberdzic et al., 2013) has recently been de-
veloped, and has shown satisfactory basic psychometric properties (Biberdzic et al., 2017). The recent validation study of the IPO-A
also supported the hypothesis that the clinical presentation of PO may differ in adolescents, with results suggesting a somewhat
different factor structure in adolescents than in young adults (e.g. a narcissistic component appeared to be specific to adolescents, and
was associated with low moral functioning; Biberdzic et al., 2017). Further research is however needed to capitalize on these early
results and add to our understanding of adolescent personality and the role of PO more specifically. At this point, it remains unclear
whether Kernberg's typology of PO manifests differently in adolescence given the important structural changes that occur during this
period, and whether the adolescent version of the IPO (IPO-A) is an appropriate instrument to assess adolescent personality subtypes,
despite preliminary findings regarding the validity of the instrument (Biberdzic et al., 2017).
3. The current study
The first aim of this study was to examine (a) whether the three hypothesized levels of PO (excluding PPO) described in adults
would manifest differently in a community sample of adolescents, and (b) how these levels of PO were related to various facets of
adjustment and functioning in youth. PPO was excluded from the hypotheses because a non-clinical sample of adolescents was used
in this study, thus reducing the probability of having a psychotic group among the participants. The second aim was to establish cut-
off scores for each of the three hypothesized POs in order to further establish the predictive validity and utility of the IPO-A.
Consistent with results of previous studies suggesting that personality pathology in adolescents is stable throughout adulthood
(Courtney-Seidler et al., 2013) but may vary in symptomatology and severity when compared to adults, as well as recent findings
regarding personality structure differences between adolescents and adults in non-clinical samples (Biberdzic et al., 2017), we hy-
pothesized that evidence for a three-level model of PO would remain robust in adolescents, but would present specific differences in
their clinical presentations. More specifically, we expected identity disturbance to be more generalized across the different POs in
adolescents, and narcissistic features and poor moral functioning to be more specific of the BPO level (see Biberdzic et al., 2017).
Considering that the adolescents in this study were also from a community sample, we hypothesized the existence of a normal, a
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neurotic, and a borderline level of PO, with individuals with a normal level of PO showing more integrated identities, more mature/
less primitive defenses, intact reality testing, lower rates of aggression, and better moral functioning than those with neurotic and
borderline levels of PO.
In addition, because one of our main concerns was to investigate in what way different POs were related to adaptation and
personality functioning in adolescents, we examined whether the different POs showed differential patterns of symptomatology and
psychosocial adjustment. The features included the quality of interpersonal relationships, as well as various internalizing and ex-
ternalizing problems (see Measures section below). Consistent with Kernberg's (1996) theory of PO, we hypothesized that higher-
level individuals would have better psychosocial adjustment and functioning than those with lower-level POs. A nonclinical sample
was chosen for the current study, partly because this sampling strategy allows to collect a large quantity of data, but also because
student samples typically contain a fairly wide range of functioning with respect to PO (Ellison & Levy, 2012). Although most
students are typically high functioning, previous studies suggest that significant borderline personality features, such as anger,
affective instability, impulsivity, and deliberate self-injury, are common in student samples (Gratz, 2001; Gratz, Conrad, & Roemer,
2002; Lenzenweger, Clarkin, Kernberg, & Foelsch, 2001; Trull, 1995). Thus, testing difficulties in personality functioning in a sample
of adolescents across the full range of PO, including those with significant risk factors for psychopathology, is consistent with both the
aims of a developmentally sensitive assessment of personality, and the expanding theoretical and empirical consensus that person-
ality functioning in general is often better described dimensionally than categorically (Krueger & Markon, 2014).
4. Method
4.1. Participants and procedure
Participants in this study were 430 adolescents from a large Canadian city who took part in a larger study that aimed to assess
adolescent personality and functioning in general. Participants were approached directly in high schools, once the approval of the
Faculty was obtained. The details of the study were explained and informed written consent was given online, using our estab-
lishment's web platform (PIANO). The research was approved by our University Ethics Committee, and all participants completed the
questionnaires online during their own free time. Participants' ages ranged from 13 to 19 (M = 16.55, SD = 1.83) and 66% (n = 283)
of the sample was female. The primary ethnic identity of the sample was 90.6% Caucasian, 2.4% Asian, 1.4% African Canadian, 1.4%
Hispanic/Latino, and 1.8% other ethnicities. Participants were able to save their results and complete the questionnaires at any later
time, and were offered a chance to win a 50$ value gift certificate by taking part in the study.
4.2. Measures
4.2.1. IPO-A (Biberdzic et al., 2013)

The IPO-A is a 42-item self-report questionnaire designed to measure the five dimensions of PO in adolescents. This version was
obtained following the validation of the initial 91-item version (Biberdzic et al., 2017), which consisted of the five original di-
mensions and of an added (i.e. empirically derived) subscale measuring instability of goals. Since we were interested in validating
theoretical assumptions regarding PO, the original dimensions of the 91-item IPO-A were used in this study instead of the factors
obtained in the recently validated 42-item version. These dimensions are: Identity Diffusion (ID; 29 items), Primitive Defenses (PD;
16 items), Impaired Reality Testing (RT; 20 items), Aggression (AGG; 18 items), and Moral Functioning (MOR; 8 items). Items are
rated on a 5-point Likert-type scale ranging from never true to always true. The IPO-A has shown high internal consistency on all five
dimensions used in this study (ID Cronbach's α = .91; PD Cronbach's α = .88; RT Cronbach's α = .90; AGG Cronbach's α = .91; MOR
Cronbach's α = .88) as well as high convergent validity (Biberdzic et al., 2017).
4.2.2. Self-Concept Clarity Scale (SCCS; Campbell et al., 1996)

The SCCS is a 12-item self-report measure designed to assess the extent to which a person's self-beliefs are clearly and confidently
defined, internally consistent, and stable. Items are rated on a 5-point Likert-type scale ranging from strongly disagree to strongly agree.
The SCCS has shown adequate internal consistency in this study (Cronbach's α = .81).
4.2.3. Defense Style Questionnaire–40 (DSQ-40; Andrews, Singh, & Bond, 1993)
The DSQ-40 uses 40 items rated on a 9-point Likert-type scale to measure 20 distinct defense mechanisms. The measure has shown
adequate internal consistency and reliability in both adult (Andrews et al., 1993) and adolescent samples (Ruuttu et al., 2006). The
theoretically based hierarchy of defense styles has been shown to relate to the severity of psychiatric symptoms among college
students, psychiatric outpatients, and community controls (Ruuttu et al., 2006) and discriminates between individuals with BPD and
other PDs (Zanarini, Weingeroff, & Frankenburg, 2009). The DSQ-40 has shown adequate internal consistency in the current study
(Cronbach's α = .82).
4.2.4. Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, 1995)
The BORRTI is a self-report inventory consisting of 90 descriptive true–false statements answered according to the respondent's
most recent experience. Scoring yields four factor-analytically derived object relations subscales: alienation, insecure attachment,
egocentricity, and social incompetence; and three reality testing subscales: reality distortion, uncertainty of perception, and hallu-
cinations and delusions. In the current study, only the reality testing subscales were used and have shown adequate internal
34
consistency (Cronbach's α = .83).
4.2.5. State-Trait Anger Expression Inventory–2 (STAXI-2; Spielberger, 1999)

The STAXI-2 was developed to assess state anger, trait anger, and anger expression. The State Anger scale assesses the intensity of
anger as an emotional state at a particular time. The Trait Anger scale measures how often angry feelings are experienced over time.
The Anger Expression scale assesses the expression of angry feelings toward other persons or objects in the environment. The STAXI-2
has been adapted for children and adolescents (STAXI-2 C/A) and has shown adequate internal consistency in both adult (Spielberger,
1999) and adolescent populations (del Barrio, Aluja, & Spielberger, 2004). Only the Trait Anger scale was used in the current study
4.2.6. Severity Indices for Personality Problems (SIPP-118; Verheul et al., 2008)
The SIPP-118 is a self report questionnaire, consisting of 118 items, measuring the core components of (mal)adaptive personality
functioning. Only the Trustworthiness subscale/facet was used in this study. This scale assesses whether one has internalized the
values and norms of social collaboration and is normally able to behave in accordance to these. The SIPP-118 has shown good
psychometric properties in both adult (Verheul et al., 2008) and adolescent (Feenstra, Hutsebaut, Verheul, & Busschbach, 2011)
samples. It's internal consistency was also satisfactory in the current study (Cronbach's α = .88).
4.2.7. Pathological Narcissism Inventory (PNI; Pincus et al., 2009)

The PNI is a 52-item self-report measure assessing 7 dimensions of pathological narcissism spanning problems with narcissistic
grandiosity (Exploitativeness, Grandiose Fantasy, Self-sacrificing Self-enhancement) and narcissistic vulnerability (Entitlement Rage,
Contingent Self-esteem, Hiding the Self, Devaluing). It uses a 6-point scale ranging from 0 (not at all like me) to 5 (very much like
me). In nonclinical samples, the PNI has shown to be positively correlated with depressive temperament, shame, aggression, in-
terpersonal problems, and BPO (Pincus et al., 2009). The PNI has shown adequate internal consistency in this study (Cronbach's
α = .89).
4.2.8. Borderline Personality Features Scale (BPFS; Crick, Murray-Close, & Woods, 2005)
The BPFS is the only dimensional measure to date specifically developed to assess borderline personality features in children and
adolescents. Adapted from the BPD scale of the Personality Assessment Inventory (PAI), it has the same four subscales (Affective
Instability, Identity Problems, Negative Relationships, and Self-harm), and six items per subscale. The questionnaire has shown
adequate psychometrics properties in both children and adolescent inpatient settings (Chang, Sharp, & Ha, 2011). It's internal
consistency in this study was also adequate (Cronbach's α = .84).
4.2.9. Youth Self-Report (YSR; Achenbach, 1991)

The YSR is a self-report questionnaire consisting of 112 problem items covering different symptoms/behaviors each to be rated on
a three-point scale (2 indicates that the symptom is present most of the time or applies well, 1 indicates that the symptom is present
some of the time or applies to some extent, and 0 indicates the absence of symptom or problem behavior). The YSR total problem
scale can be divided into nine syndrome subscales: Withdrawn, Somatic complaints, Anxious/Depressed, Social problems, Thought
problems, Attention problems, Delinquent behavior, Aggressive behavior, and Selfdestructive/Identity problems. Withdrawn,
Somatic complaints and Anxious/Depressed together comprise a broad internalizing dimension, whereas Delinquent and Aggressive
behaviors together constitute an externalizing dimension. The YSR has shown adequate internal consistency in this study (Cronbach's
α = .82).
4.2.10. The early adolescent temperament questionnaire - revised (EATQ-R; Putnam, Ellis, & Rothbart, 2001)
The short version of the EATQ-R is an instrument consisting of 65 items with answers gauged on a 5-point Likert scale ranging
from 1 = almost never true to 5 = almost always true. The revised questionnaire assesses 10 aspects of temperament related to self-
regulation in adolescents, including activation control, affiliation, attention, fear, frustration, high-intensity pleasure, inhibitory
control, perceptual sensitivity, pleasure sensitivity, and shyness. It also contains 2 behavioral scales (Aggression scale and Depressive
mood scale). The EATQ-R has shown adequate internal consistency in this study (Cronbach's α = .87).
4.2.11. Dickman's Impulsivity Inventory (DII; Dickman, 1990)

The DII-short is a self-report questionnaire developed to measure two types of impulsivity, namely Functional and Dysfunctional
Impulsivity. It consists of 23 items to be answered with a true/false answer format. Eleven items were written to tap functional
impulsivity and consists of items such as “I would enjoy working at a job that required me to make a lot of split-second decisions” and
“People have admired me because I can think quickly”. Another 12 items were designed to tap dysfunctional impulsivity and consists
of items such as “I often say and do things without considering the consequences” and “I often say whatever comes into my head
without thinking first”. The DII has shown adequate internal consistency in this study (Cronbach's α = .90).
4.2.12. Inventory of Interpersonal Problems-short (IIP-32; Horowitz, Alden, Wiggins, & Pincus, 2000)
The IIP-32 is a 32-item self-report inventory developed to assess patient social adjustment and interpersonal difficulties. It consists
of 8 different scales: Domineering/Controlling, Vindictive/Self-Centered, Cold/Distant, Socially Inhibited, Nonassertive, Overly
Accommodating, Self-Sacrificing, Intrusive/Needy. High scores are indicative of poorer interpersonal functioning. The IIP-32 has
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shown adequate internal consistency in this study (Cronbach's α = .88).
4.2.13. Beck Youth Inventories-2nd edition (BYI-II; Beck, Beck, Jolly, & Steer, 2005)
The BYI-II are five self-rating scales assessing young people's emotional and social impairment in terms of depression, anxiety,
anger, disruptive behavior, and self-concept. Only the depression and anxiety inventories were used in this study. Each inventory
consists of 20 items that are self-rated on a 4-point scale of 0–3. The BYI-II has shown adequate internal consistency in this study
4.2.14. Self-Perception Profile for Adolescents (SPPA; Harter, 1988)

The SPPA is a 45-item measure of competence in adolescents between the ages of 13 and 18 years. It is designed to measure
teenagers' perception of their competence in, and the importance to them in the following 8 domains: scholastic competence, social
acceptance, athletic competence, physical appearance, job competence, romantic appeal, behavioral conduct, and close friendship.
The SPPA has shown adequate internal consistency in this study (Cronbach's α = .90).
4.3. Statistical analyses
To investigate whether three distinct personality types (or POs) could be distinguished in a non-clinical sample of adolescents, we
conducted both two-step cluster analyses (CA) and Q-factoring analyses (QFA) in SPSS 20. Receiver operating characteristic (ROC)
curve analyses were conducted to assess the IPO-A's core dimensions capacity to discriminate between the different types of POs. ROC
curve analyses were evaluated via SPSS and confirmed using MedCalc 15.2.2.
QFA is similar to CA in the sense that it can be used to group participants together based on the similarity of their profiles. The two
methods however use different measures of case similarity as well as different statistical procedures in assessing group membership.
Both of these commonly used methods were therefore conducted in order to reduce method biases as well as to add additional
information regarding the nature of the inter-group/cluster differences.
In the first step of the two-step CA, preclusters are formed that are merged successively with similar preclusters in the second step.
The continuous variables are standardised by default in this procedure, and the number of clusters can be determined automatically
by the statistical package based on the Schwarz Bayesian Information Criterion (BIC). In this study, the scores of the adolescents on
the five main scales of the IPO-A served as the input variables for the CAs, and the automated cluster solution was based on the
default BIC. Log-likelihood was the distance measure selected, defining the normal density for continuous variables. Average
Silhouette Coefficient (a measure of how tightly grouped all the data in the cluster are) measured the goodness-of-fit (Rousseeuw,
1987). This index combines both cohesion (based on the average distances between all the objects into a cluster) and separation
(based on the average distance of any object to all the other objects not contained into the same cluster), and can range between 0
and 1; values between 0 and 0.2 are indicative of poor fit, between 0.2 and 0.5 are considered fair and indices above 0.5 are
considered good.
Similarly, QFA categorizes subjects based on their patterns of responses. It establishes patterns across individuals; that is, the
patterns are generated from individuals' similar responses on selected items, in this case on the 91 items of the IPO-A. Therefore,
unlike traditional factor analysis, QFA groups cases rather than variables (Newman & Ramlo, 2010). An inverted matrix consisting of
intercorrelations among participants is first produced. This “Q-matrix” is then subjected to conventional factor analytic techniques
(McKeown & Thomas, 1988). For this study, principal components analysis followed by Varimax rotation was performed to generate
Q-factors from the Q-matrix (McKeown & Thomas, 1988). Parallel analysis (O'Connor, 2000) was used to decide the number of Q-
factors to extract. Following extraction, the normalized factor scores (i.e., generated z scores) are used to compare the characteristics
of each group. In complement to CA, QFA thus provides additional information in understanding the Q-factors/clusters by observing
extremely ranked items and distinguishing items.
ROC curve analysis, on the other hand, is a tool for assessing the accuracy of a test to discriminate between clinical and non-
clinical cases (Metz, 1978). In a ROC curve, the true positive rate (Sensitivity) is plotted in function of the false positive rate (100-
Specificity) for different cut-off points of a parameter. Each point on the ROC curve represents a sensitivity/specificity pair corre-
sponding to a particular decision threshold. The trade-off between sensitivity and specificity is graphically displayed and is used to
assign the best cut-off points (Boyd, 2007). The closer the ROC curve is to the upper left corner, the higher the overall accuracy of the
test, whereas a ROC curve lying on the diagonal line reflects the performance of a diagnostic test that is no better than chance level,
i.e. a test which yields the positive or negative results unrelated to the true status (Zweig & Campbell, 1993). The derived summary
measure of accuracy, the area under the ROC curve (AUC), is used to determine how well a parameter can distinguish between two
groups (e.g. clinical/non-clinical group). The AUC is a global measure regarding the performance of a scale. In this study, it cor-
responds to the probability that a randomly chosen adolescent with a given PO (e.g., BPO) will have a higher score on a corre-
sponding IPO-A scale than a randomly chosen adolescent without this condition. Guidelines applied in biomedical domains (Fischer,
Bachmann, & Jaeschke, 2003) were suggested in psychiatry (Streiner & Cairney, 2007) to interpret AUC values: high accuracy
(> 0.90), moderate (0.70–0.90), low (< 0.70), and chance-level accuracy (0.50). For every IPO-A scale, we calculated sensitivity
(ability to detect youth with psychopathology), specificity (ability to detect youth without psychopathology), false positive (FP: 1 –
specificity), and false negative (FN: 1 – sensitivity). The likelihood ratio positive (LR+) was calculated for all cutoff points on the
IPO-A scales. Each LR+indicates how more likely adolescents with a given psychopathology will yield a score equal to or above the
cutoff points compared to those without this condition. The Youden index (which gives equal weight to potential errors of both
sensitivity and specificity) is an indicator commonly used to determine the optimal cut-off score. It optimizes the instrument's
36
Table 1
Differences between clusters on measures of personality, psychopathology, and functioning.
Measures Cluster 1 Normal Cluster 2 Neurotic Cluster 3 Borderline F(2, 233) Comparison between clusters:
(n = 98) (n = 104) (n = 31) Cohen's d
M SD M SD M SD C1 vs C2 C1 vs C3 C2 vs C3
a b c
IPO-PD 28.51 5.18 38.62 4.94 50.81 6.12 239.78*** 2.00 3.93 1.99
IPO-ID 63.36a 8.35 79.31b 7.24 94.52c 8.41 217.31*** 2.04 3.72 1.94
IPO-RT 31.29a 6.81 43.03b 6.00 60.03c 8.29 233.04*** 2.22 3.92 2.03
IPO-AGG 22.03a 2.83 28.36b 5.13 40.84c 10.87 139.41*** 1.54 2.67 1.89
IPO-MOR 14.78a 3.43 19.49b 3.70 24.32c 3.56 102.36*** 1.72 2.63 1.09
SCCS 41.67a 10.18 33.35b 10.06 21.91c 7.07 21.08*** 1.20 2.28 1.32
DSQ-Immature 2.60a 0.97 3.20b 1.37 4.98c 1.21 18.39*** 0.50 2.17 1.37
BORRTI 19.61a 0.57 19.06b 1.05 17.81c 2.09 14.34*** 0.65 1.46 0.90
STAXI-Trait 15.96a 3.08 18.64b 3.74 22.06c 5.35 17.41*** 0.78 1.21 0.74
SIPP-118-Trust 3.52a 0.47 3.19a 0.46 2.48b 0.23 12.18*** – 1.24 1.95
PNI 2.92a 0.51 3.41b 0.43 3.94c 0.47 49.52*** 1.05 2.27 1.24
BPFS 45.82a 8.78 58.37b 9.93 75.10c 9.11 72.75*** 1.73 3.68 1.85
YSR-Conduct Problems 1.33a 1.54 2.90b 2.48 4.88c 2.47 16.47*** 0.72 1.42 0.72
YSR-Affective Problems 4.71a 3.36 7.52b 3.98 11.56c 3.10 21.41*** 0.81 2.99 1.83
YSR- Thought Problems 3.05a 1.62 7.12b 3.44 10.25c 3.38 43.65*** 1.10 2.68 1.10
EATQ-Negative 3.88a 0.68 4.04ab 0.87 4.79b 0.57 3.14ϯ – 1.45 –
Affectivity
DII-Dysfunctional 24.94a 6.05 28.08ab 5.75 35.33b 4.23 7.25** – 1.99 1.44
IIP-32 34.77a 18.44 46.31b 10.53 59.56c 15.02 17.24*** 1.02 1.74 0.92
BYI-II 8.85a 5.25 16.52b 8.15 23.75c 14.16 10.27*** 1.03 2.19 –
SPPA-Behavioral Conduct 3.61a 0.40 3.19b 0.51 2.82c 0.60 11.71*** 1.31 1.88 –
SPPA-Global Self-Worth 3.15a 0.64 2.75b 0.65 2.24c 0.50 7.97** 0.99 2.12 –
Note. N = 145. Means with different superscripts are significantly different from each other. IPO = Inventory of Personality Organization; IPO-PD
= Primitive Defenses scale of the IPO; IPO-ID = Identity Diffusion scale of the IPO; IPO-RT = Reality Testing scale of the IPO; IPO-AGG =
Aggression scale of the IPO; IPO-MOR = Moral Values scale of the IPO; SCCS = Self-Concept Clarity Scale total score; DSQ-Immature = Immature
and Primitive scales combined of the Defense Style Questionnaire-40; BORRTI = Reality Testing scale of the Bell Object Relations and Reality
Testing Inventory; STAXI-Trait = Trait Anger scale of the State-Trait Anger Expression Inventory–2; SIPP-118-Trust = Trustworthiness facet of the
Severity Indices for Personality Problems; PNI = Pathological Narcissism Inventory; MFQ = Moral Foundations Questionnaire; BPFS = Borderline
Personality Features Scale; YSR-Conduct Problems = Conduct Problems scale of the Youth Self-Report; YSR-Affective Problems = Affective
Problems scale of the Youth Self-Report; YSR-Thought Problems = Thought Problems scale of the Youth Self-Report; EATQ-Negative
Affectivity = Negative Affectivity scale of the Early Adolescence Temperament Questionnaire; DII-Dysfunctional = Dysfunctional Impulsivity scale
of the Dickman's Impulsivity Inventory; IIP-32 = Inventory of Interpersonal Problems; BYI-II = Beck's Youth Inventories; SPPA-Behavioral
Conduct = Behavioral Conduct scale of the Self-Perception Profile for Adolescents; SPPA-Global Self-Worth = Total score of the Self-Perception
Profile for Adolescents.
ϯ
p ≤ .06 **p ≤ .01 ***p ≤ .001.
differentiating ability when equal weight is assigned to sensitivity and specificity (Bergeron et al., 2017).
Finally, analyses of variance (ANOVA) were used to further differentiate the groups by comparing the empirical clusters on
various measures of psychopathology and functioning. Cohen's d measured the effect size of proportions and mean differences. Due to
the multiple statistical comparisons, Tukey-Kramer's correction was applied to avoid bias due to Type-I error.
5. Results
5.1. Two-step cluster analysis
CA was first carried out on the adolescents' scores on the IPO-A. Three clusters emerged, with sample sizes of 184 (42.8%), 189
(43.9%) and 57 (13.3%). The ratio of sizes comparing the largest to the smallest cluster was 1.80. Goodness-of-fit was achieved, with
the average Silhouette Coefficient equal to 0.50. Cluster 1 consisted of individuals with lower scores on all five dimensions of PO,
namely primitive defenses, identity diffusion, reality testing, aggression, and moral values, and was thus labelled Normal PO. Cluster
2 consisted of individuals who had intermediate (i.e. nor high, nor low) scores on all five dimensions of the IPO-A in comparison to
the other two clusters, and was thus labelled Neurotic PO. Finally, Cluster 3 was labelled Borderline PO, considering that individuals
in this cluster had the highest scores on all five dimensions of PO. It is important to note that the names of the groups were chosen for
consistency reasons, in line with existing terminology regarding PO, and that these categories are not intended as clear diagnoses.
Table 1 shows the comparison of different psychopathology/symptomatology scales and psychosocial functioning indicators' mean
scores between clusters.
ANOVA tests revealed significant mean differences between at least two clusters for all the scales. Post-hoc comparisons showed
that the three clusters differed on a significant number of measures, with the highest mean scores on psychopathology (and lowest
scores on functioning) being for individuals in cluster 3 (Borderline PO) followed by cluster 2 (Neurotic PO). Effect sizes were
37
medium (d = 0.50) to very large (d = 3.93). More specifically, in comparison to adolescents from the Borderline PO group (Cluster 3;
n = 57), adolescents from the Normal PO group (Cluster 1; n = 184) had: a clearer understanding of themselves (i.e. sense of self); a
reduced usage of primitive defenses; better reality testing; lower levels of aggression; more integrated moral values; less narcissistic
and borderline traits; less internalizing and externalizing behavior problems; less depressive symptoms and negative affect; less
impulsivity; less interpersonal problems; and had a more positive perception of themselves in general. Compared to adolescents with
a Neurotic PO (Cluster 2; n = 189), adolescents with a Normal PO also had: a clearer sense of self; less internalizing behavior
problems; less interpersonal problems; a more positive perception of themselves; and used less primitive defenses in general. Finally,
in comparison to adolescents from the neurotic PO group, adolescents from the Borderline PO group had: greater use of primitive
defenses; more impaired sense of self and reality testing; higher narcissistic and borderline traits; higher levels of aggression toward
others; poorer moral functioning; more depressive symptoms and negative affect; more internalizing and externalizing behavior
problems in general; and more often experienced interpersonal problems.
Post-hoc comparisons also revealed that there were no significant differences between adolescents classified as having a Normal
PO and those classified as having a Neurotic PO with regard to impulsivity, externalizing behavior, moral functioning, and their
capacity to regulate aggression. There were also no significant differences between these two groups with regard to reality testing,
depressive symptoms, and the grandiose scales of the PNI. Both of these groups however differed significantly from the Borderline PO
group on these same variables. With regard to adolescents classified as part of the Borderline PO and those classified as part of the
Neurotic PO group, there were no significant differences between these two groups on specific scales of interpersonal problems such
as being cold/distant, socially inhibited, non-assertive and/or overly accommodating, although those from the Borderline PO group
reported having more interpersonal difficulties overall. Both of these groups however differed respectively from adolescents classified
as having a Normal PO, who reported significantly less interpersonal difficulties of this nature.
5.2. Q-factor analysis
Following the CAs, QFAs were conducted on the adolescents' IPO-A scores. Parallel analysis (O'Connor, 2000) for the 95th
percentile in 1000 random data sets suggested a four-component solution. At root 5, the actual eigenvalue (5.34) fell below the mean
random data eigenvalue (5.50) and percentile (5.62). We thus considered four components (Q-factors) a maximum, and examined
three- and four-component solutions. Participants who strongly loaded on a given component were considered to be definers of that
specific component and were assumed to share a common PO. The three-component solution was understandable and similar to the
one previously found with the CA. At four components, there was no change except for the addition of a redundant factor tapping
additional variations of unstable representations of self and others. Thus, we concluded this did not enhance the overall solution
beyond three components. We thus chose to extract the three Q-factor solution instead.
Tables 2–4 contain the statements, in bold characters, that characterize the three derived personality types (or POs) most strongly
(z ≥ 1.00) and the least strongly (z ≤ −1.00). These extremely ranked statements suggest that the first group (n = 181) was com-
posed of individuals with stable commitments (as suggested by high z scores on items such as “I know what I want to become and I'm
working on it”), intact reality testing (as suggested by high negative z scores on items such as “I have seen things which do not exist in
reality”), low levels of aggression (as suggested by high negative z scores on items such as “I find the suffering of other people
exciting”) and somewhat fluctuant and uncertain representations of self and others (as suggested by high z scores on items such as “I
feel I'm a different person at home as compared to how I am at work or at school” and “I am not sure what others think of me, even
people who know me very well”). The second group (n = 196) was composed of individuals with unstable representations of self and
others (as suggested by high z scores on items such as “When others see me as having succeeded, I'm delighted and, when they see me
Table 2
Salient (z > |1.0|) factor scores and distinguishing items for Q-factor 1.
Item z score
Q-factor 1 Q-factor 2 Q-factor 3
89. There are many things one can do in life, but I know that what I want to do will remain the same. 3.50 .37 1.08
87. I know what I want to become, and I've mapped out steps to get there. 1.74 −.21 −.55
82. I know what I want to become and I'm working on it. 1.71 −.46 −1.21
85. I stick to my plans over the years 1.67 .10 .08
84. When I become friends with someone, I know it will last for a long time. 1.63 .24 −.07
62. I am not sure what others think of me, even people who know me very well. 1.39 1.87 .90
7. I feel I'm a different person at home as compared to how I am at work or at school. 1.15 1.59 1.46
71. I have seen things which do not exist in reality. −1.26 −1.24 −1.08
56. I find the suffering of other people exciting. −1.18 −1.59 −1.30
38. I hear things that do not exist according to others. −1.18 −1.43 −1.11
33. I can see or hear things that others cannot see or hear. −1.16 −1.07 −.59
68. It is a big relief to hurt or cut myself. −1.15 −.98 −1.40
34. I enjoy inflicting pain to others. −1.14 −1.41 −1.26
64. I enjoy making other people suffer. −1.13 −1.70 −1.36
75. I have made at least one suicide attempt. −1.12 −1.62 −1.34
43. I have heard or seen things when there is no apparent reason for it. −1.08 −1.22 −.81
38
Table 3
Item z score
62. I am not sure what others think of me, even people who know me very well. 1.39 1.87 .90
54. When others see me as having succeeded, I'm delighted and, when they see me as failing, I feel devastated. .80 1.84 .75
58. I am afraid that people who are important to me will suddenly change their feelings towards me. .73 1.70 2.15
83. I don't know why, but I never quite know how to conduct myself with people. .51 1.64 −.01
7. I feel I'm a different person at home as compared to how I am at work or at school. 1.15 1.59 1.46
17. Some of my friends would be surprised to see how differently I behave in certain situations. .62 1.32 .69
32. I can't explain the changes in my behavior. .39 1.27 .42
70. Sometimes, I see myself as a totally different person. −.09 1.24 1.14
1. I am a “hero worshiper” even if I find later on that I was wrong. .79 1.23 .73
69. I tend to feel things in a somewhat extreme way, experiencing either great joy or great sadness. −.22 1.18 .90
67. I know that I cannot tell others certain things I understand about the world because these things would seem crazy to .34 1.02 1.46
them.
24. I have seriously harmed someone but it was in self-defense. −.89 −1.38 −.60
48. I like feeling that others are afraid of me. −.98 −1.37 −.95
27. People tell me I provoke or manipulate them to get what I want. −.79 −1.29 −1.13
4. I have been told that I like seeing other people suffer. −.86 −1.25 −1.29
10. The wealth is divided so unfairly that I would have the right to take things that are not mine, if there is no risk of −.85 −1.24 −.79
getting caught.
43. I have heard or seen things when there is no apparent reason for it. −1.08 −1.21 −.80
29. I have been told that I try to control others by making them feel guilty. −.93 −1.08 −1.11
33. I can see or hear things that others cannot see or hear. −1.15 −1.07 −.58
Table 4
Item z score
5. Everybody would steal if there were no risks of getting caught. .67 −.37 2.64
45. I think people are basically either good or bad: there are few who are really in between. .13 −.36 2.22
58. I am afraid that people who are important to me will suddenly change their feelings towards me. .73 1.67 2.14
40. I am lucky to be free of the guilt feelings that bother others and restrict lives. .01 −.82 1.83
31. I often have difficulty seeing flaws in those I admire. .74 .97 1.65
20. People pretend feeling guilty when, in fact, they are only afraid of being caught. .46 .23 1.61
11. It has been a long time since anyone really taught or told me something I did not already know. −.55 −.87 1.47
67. I know that I cannot tell others certain things I understand about the world because these things would seem crazy to .34 1.02 1.46
them.
63. I understand and know things that no one else can understand or know. −.75 −.11 1.45
66. Being alone is difficult for me. .63 −.11 1.28
16. It is hard for me to trust people because they often turn against me or betray me. .02 .87 1.26
46. If my life were a book, it would be more like a series of short stories written by different authors than like a long .18 .40 1.24
novel.
6. People I once thought highly of have disappointed me by not living up to what I expected of them. .57 .97 1.15
70. Sometimes, I see myself as a totally different person. −.09 1.24 1.14
89. There are many things one can do in life, but I know that what I want to do will remain the same. 3.49 .37 1.08
68. It is a big relief to hurt or cut myself. −1.15 −.98 −1.40
4. I have been told that I like seeing other people suffer. −.86 −1.25 −1.29
82. I know what I want to become and I'm working on it. 3.11 −.45 −1.21
27. People tell me I provoke or manipulate them to get what I want. −.79 −1.29 −1.13
51. I can't tell whether certain physical sensations that I'm having are real, or whether I am imagining them. −.97 −.61 −1.12
29. I have been told that I try to control others by making them feel guilty. −.93 −1.08 −1.11
39
Table 5
Summary of the results from Cluster Analysis and Q-Factor Analysis.
Characteristic features across the groups
Normal PO (n = 184) Neurotic PO (n = 189) Borderline PO (n = 57)
Cluster Analysis Low use of primitive defenses Moderate use of primitive High use of primitive defenses
defenses
Most integrated representations of self and Moderate instability in Most unstable representations of self and others
others representations of self and
others
High reality testing Moderate reality testing Poor reality testing
Low levels of aggression Moderate levels of aggression Highest levels of aggression
High moral functioning Moderate moral functioning Poor moral functioning
Q-Factor Normal PO (n = 181) Neurotic PO (n = 196) Borderline PO (n = 53)

Analysis Stable commitments and stable representations Unstable representations of self Unstable (and more grandiose) representations of
of others, despite fluctuant and uncertain self, and unstable (and more distrusting)
representations of self representations of others
Low levels of aggression Low levels of aggression Low levels of aggression
High moral functioning High moral functioning Lower moral functioning
Intact reality testing Intact reality testing Intact reality testing
as failing, I feel devastated” and “I am not sure what others think of me, even people who know me very well ”), low rates of
aggression (as suggested by high negative z scores on items such as “I have seriously harmed someone but it was in self-defense”,
good moral functioning (as suggested by high negative z scores on items such as “The wealth is divided so unfairly that I would have
the right to take things that are not mine, if there is no risk of getting caught”), and intact reality testing (as suggested by high
negative z scores on items such as “I have seen things which do not exist in reality”). Finally, the third group (n = 53) was also
composed of individuals with intact reality testing and low levels of aggression (as suggested by high negative z scores on items such
as “I can't tell whether certain physical sensations that I'm having are real, or whether I am imagining them” and “I have been told
that I like seeing other people suffer”) but with lower moral functioning (as suggested by high z scores on items such as “Everybody
would steal if there were no risks of getting caught” and “I am lucky to be free of the guilt feelings that bother others and restrict
lives”), unstable representations of self and others (as suggested by high z scores on items such as “If my life were a book, it would be
more like a series of short stories written by different authors than like a long novel “ and “It is hard for me to trust people because
they often turn against me or betray me”), and a grandiose sense of self (as suggested by high z scores on items such as “I feel it has
been a long time since anyone really taught or told me anything I did not already know” and “People I once thought highly of have
disappointed me by not living up to what I expected of them”). Consistent with the terminology of the previously defined clusters of
PO, the first group was labelled Normal PO, the second Neurotic PO, and the third Borderline PO (see Table 5 for a summary).
5.3. Establishing cut-off scores
Discriminant validity of each IPO-A scale/dimension was assessed using ROC curves and the corresponding area under the curve
(AUC) in predicting cluster membership (1 for Normal, 2 for Neurotic, or 3 for Borderline PO). The classification obtained by Cluster
Analysis was used to establish the cut-off scores, considering that Q-Factor analysis does not provide cluster membership and relies on
an inverted data matrix. To identify optimal thresholds for Normal, Neurotic, and Borderline PO for each scale, sensitivity, specificity,
positive and negative predictive values, positive and negative likelihood ratios, and Youden's index (Youden, 1950) were compared
across a range of cut-points. For each index, higher values indicate more accurate discrimination and greater test effectiveness.
Considering that Neurotic PO lies on a continuum between Normal and Borderline PO, and that ROC curve analysis requires a binary
indication of direction (i.e. either larger or smaller results being indicative of the desired outcome), cut-off scores for the Neurotic PO
were established once the optimal thresholds for the other two POs were identified. All five scales had high concordance and
classification effectiveness for the targeted Normal and Borderline PO as indicated by the ROC curves shown in Figs. 1 and 2.
With regard to the Normal PO, the AUCs ranged between .91 (95% CI 0.85–0.95) for the Aggression subscale and .98 (95% CI
0.94–1.00) for the Identity Diffusion subscale as shown in Table 6. As for the Borderline PO, the AUCs ranged between 0.86 (95% CI
0.79–0.91) for the Moral Values subscale and 0.98 (95% CI 0.94–1.00) for the Primitive Defenses subscale as shown also in Table 6.
Tables 7 and 8 present the indices of classification accuracy (sensitivity, specificity, positive and negative predictive values,
positive and negative likelihood ratios, and Youden's index) across a range of cut-points for each scale of the IPO-A, for the Normal
and Borderline POs respectively. In sum, scores lower than (and equal to) 32 on Primitive Defenses, 71 on Identity Diffusion, 36 on
Reality Testing, 24 on Aggression, and 17 on Moral Values are representative of a Normal PO. Scores higher than (and equal to) 46 on
Primitive Defenses, 85 on Identity Diffusion, 50 on Reality Testing, 32 on Aggression, and 22 on Moral Values are representative of a
Borderline PO. Therefore, scores ranging inclusively between 33 and 45 on Primitive Defenses, 72 and 84 on Identity Diffusion, 25
and 49 on Reality Testing, 25 and 31 on Aggression, and 18 to 21 on Moral Values are representative of a Neurotic PO.
40
Fig. 1. ROC curves and AUCs for the Primitive Defenses (IPO-PD), Identity Diffusion (IPO-ID), Reality Testing (IPO-RT), Aggression (IPO-AGG), and
Moral Values (IPO-MOR) Scales of the IPO in predicting Normal PO classification.
Fig. 2. ROC curves and AUCs for the Primitive Defenses (IPO-PD), Identity Diffusion (IPO-ID), Reality Testing (IPO-RT), Aggression (IPO-AGG), and
Moral Values (IPO-MOR) Scales of the IPO in predicting Borderline PO classification.
41
Table 6
AUCs for the IPO scales in Normal and Borderline PO.
Scale AUC SE z statistic 95% CI
Normal PO
IPO-PD 0.94 0.01 30.60*** 0.90–0.96
IPO-ID 0.94 0.01 32.92*** 0.91–0.97
IPO-RT 0.92 0.02 22.57*** 0.88–0.95
IPO-AGG 0.90 0.02 19.74*** 0.85–0.93
IPO-MOR 0.88 0.02 16.84*** 0.83–0.92
Borderline PO
IPO-PD 0.98 0.01 53.07*** 0.95–0.99
IPO-ID 0.96 0.01 35.60*** 0.92–0.98
IPO-RT 0.98 0.01 56.42*** 0.95–0.99
IPO-AGG 0.92 0.03 15.09*** 0.88–0.95
IPO-MOR 0.89 0.03 15.41*** 0.85–0.93
Note. N = 145. AUC = Area under the curve. IPO = Inventory of Personality Organization; IPO-PD = Primitive Defenses scale of the IPO; IPO-
ID = Identity Diffusion scale of the IPO; IPO-RT = Reality Testing scale of the IPO; IPO-AGG = Aggression scale of the IPO; IPO-MOR = Moral
Values scale of the IPO.
***p ≤ .001.
6. Discussion
The aim of this study was to examine whether the main dimensions of PO, namely Primitive Defenses, Identity Diffusion, Reality
Testing, Aggression, and Moral Functioning, were empirically related to theorized levels of PO, and whether the manifestation of
these PO indicators differed in adolescents. More specifically, we examined whether three of the supposed levels of PO (i.e. Normal,
Neurotic, and Borderline PO) could be identified in a community sample of adolescents, and how these types of PO were related to
different levels of functioning and psychopathology. In addition, we wanted to further establish the validity and utility of the IPO-A,
by identifying preliminary cut-off points for each of the main dimensions of PO.
Two methods were used to identify different types of PO, namely cluster analysis and Q-factor analysis. Findings from the first
method indicated that adolescents, as expected, could be divided into three distinct groups based on their level of PO. Consistent with
theoretical assumptions (Caligor & Clarkin, 2010), the first group was composed of individuals who had a low use of primitive
defenses such as denial and splitting, more integrated identities, intact reality testing, lower levels of aggression toward others, and a
well integrated moral system. This group was thus labelled Normal PO, in line with existing terminology. In comparison with group 1,
the second group was characterized by a higher usage of primitive defenses, more unstable representations of self and others (i.e. less
integrated identities), poorer reality testing, more aggression, and poorer moral functioning. Again, in concordance with the existing
terminology, Group 2 was labelled Neurotic PO. Finally, individuals composing the third group were characterized by the highest
usage of primitive defenses; lowest levels of identity integration (or the highest levels of identity diffusion); poorest reality testing,
highest levels of aggression, and most impaired moral functioning. These individuals were thus considered as functioning at a
Borderline level of PO.
The three groups also differed, as hypothesized, on specific scales of functioning and psychopathology. Those with a Normal PO
had the highest levels of self-esteem, were less impulsive, and reported less negative affect. They also reported less narcissistic and
borderline traits, less depressive symptoms, and less interpersonal and conduct problems. At the other end of the spectrum, ado-
lescents with a Borderline PO reported the lowest levels of functioning and the highest levels of psychopathology (as measured by
their scores on the aforementioned indicators), whereas those with a Neurotic PO had intermediate levels of both functioning and
psychopathology. These results are consistent with not only the theoretical assumption that PO lies on a continuum ranging from
healthy to maladaptive functioning, and from normal to pathological personality (Caligor et al., 2007), but also with empirical
findings suggesting that adolescents with borderline personality features suffer from significantly more difficulties with regard to
emotion regulation and interpersonal functioning. For example, in a recent study using a non-clinical sample of adolescents, an
association was found between dimensionally assessed features of borderline pathology, non-suicidal self-injury, and emotion dys-
regulation (Somma, Sharp, Borroni, & Fossati, 2017). In another nonclinical sample of adolescents similar to the one used in the
current study, high scores on the core dimensions of PO (identity diffusion, primitive defense mechanisms, and impaired reality
testing) were associated with greater interpersonal problems as well as antisocial traits of callousness and impulsivity (Chabrol &
Leichsenring, 2006). The association found in the current study between adolescents classified as having a Borderline PO and their
difficulties in several areas of functioning and psychopathology underline the importance of screening adolescents at high-risk of
personality pathology.
Findings from the cluster analysis were replicated using a second classification technique (i.e. Q-factor analysis) that also
identified three distinct groups of adolescents based on the five dimensions of PO. Similar to the Normal PO previously identified,
Group 1 in this analysis was characterized by stable commitments and long-term objectives, intact reality testing, low levels of
aggression, and, to some extent, fluctuant representations of self and others. Group 2 was characterized by unstable representations of
both self and others, good moral functioning, low levels of aggression, and intact reality testing. Finally, adolescents in Group 3 were
characterized by poor moral functioning, unstable representations of self and others, and intact reality testing.
42
Table 7
Cut-off scores for the Normal PO based on the IPO scales.
Scale Criterion Sensitivity Specificity Youden's Index +LR -LR +PV -PV
IPO-PD
< 17 0.00 100.00 0.01 – 1.00 – 90.0
≤25 26.53 100.00 0.27 – 0.73 100.0 92.5
≤26 33.67 99.26 0.33 45.46 0.67 83.5 93.1
≤30 66.33 96.30 0.63 17.91 0.35 66.6 96.3
≤31 71.43 94.07 0.66 12.05 0.30 57.3 96.7
≤32 77.55 92.59 0.70 10.47 0.24 53.8 97.4
≤33 80.61 88.15 0.68 6.80 0.22 43.0 97.6
≤34 82.65 80.74 0.63 4.29 0.21 32.3 97.7
≤35 88.78 77.78 0.66 3.99 0.14 30.7 98.4
≤38 96.94 64.44 0.61 2.73 0.05 23.3 99.5
≤39 100.00 58.52 0.59 2.41 0.00 21.1 100.0
≤66 100.00 0.00 0.00 1.00 – 10.0 –
IPO-ID
< 43 0.00 100.00 0.02 – 1.00 – 90.0
≤62 43.88 100.00 0.44 – 0.56 100.0 94.1
≤63 51.02 98.52 0.50 34.44 0.50 79.3 94.8
≤69 76.53 94.07 0.71 12.91 0.25 58.9 97.3
≤70 78.57 91.85 0.70 9.64 0.23 51.7 97.5
≤71 83.67 89.63 0.73 8.07 0.18 47.3 98.0
≤72 85.71 83.70 0.69 5.26 0.17 36.9 98.1
≤73 87.76 82.22 0.70 4.94 0.15 35.4 98.4
≤74 88.78 80.74 0.70 4.61 0.14 33.9 98.5
≤79 98.98 59.26 0.58 2.43 0.017 21.3 99.8
≤80 100.00 57.78 0.58 2.37 0.00 20.8 100.0
≤118 100.00 0.00 .01 1.00 – 10.0 –
IPO-RT
< 21 0.00 100.00 0.02 – 1.00 – 90.0
≤27 30.61 100.00 0.31 – 0.69 100.0 92.8
≤28 35.71 99.26 0.35 48.21 0.65 84.3 93.3
≤33 68.37 97.04 0.65 23.07 0.33 71.9 96.5
≤34 74.49 93.33 0.68 11.17 0.27 55.4 97.1
≤35 79.59 91.11 0.71 8.95 0.22 49.9 97.6
≤36 83.67 88.15 0.72 7.06 0.19 44.0 98.0
≤37 85.71 85.19 0.71 5.79 0.17 39.1 98.2
≤38 88.78 82.96 0.72 5.21 0.14 36.7 98.5
≤39 89.80 79.26 0.69 4.33 0.13 32.5 98.6
≤50 98.98 28.15 0.27 1.38 0.04 13.3 99.6
≤54 98.98 20.00 0.19 1.24 0.05 12.1 99.4
≤55 100.00 17.78 0.18 1.22 0.00 11.9 100.0
≤80 100.00 0.00 0.01 1.00 – 10.0 –
IPO-AGG
< 18 0.00 100.00 0.06 – 1.00 – 90.0
≤19 15.31 99.26 0.15 20.66 0.85 69.7 91.3
≤20 33.67 97.04 0.31 11.36 0.68 55.8 92.9
≤22 63.27 92.59 0.56 8.54 0.40 48.7 95.8
≤23 77.55 84.44 0.62 4.99 0.27 35.6 97.1
≤24 85.71 78.52 0.64 3.99 0.18 30.7 98.0
≤25 92.86 74.07 0.67 3.58 0.10 28.5 98.9
≤26 93.88 69.63 0.64 3.09 0.09 25.6 99.0
≤27 94.90 61.48 0.56 2.46 0.08 21.5 99.1
≤33 98.98 28.15 0.27 1.38 0.04 13.3 99.6
≤34 100.00 25.19 0.25 1.34 0.00 12.9 100.0
≤64 100.00 0.00 0.01 1.00 – 10.0 –
IPO-MOR
<8 0.00 100.00 0.02 – 1.00 – 90.0
≤9 7.14 100.00 0.07 – 0.93 100.0 90.6
≤10 13.27 99.26 0.13 17.91 0.87 66.6 91.2
≤16 69.39 89.63 0.59 6.69 0.34 42.6 96.3
≤17 79.59 80.00 0.60 3.98 0.26 30.7 97.2
≤18 87.76 74.07 0.62 3.38 0.17 27.3 98.2
≤19 90.82 61.48 0.52 2.36 0.15 20.8 98.4
≤20 94.90 52.59 0.47 2.00 0.10 18.2 98.9
≤23 100.00 24.44 0.24 1.32 0.00 12.8 100.0
≤34 100.00 0.00 0.01 1.00 – 10.0 –
Note. IPO = Inventory of Personality Organization; IPO-PD = Primitive Defenses scale of the IPO; IPO-ID = Identity Diffusion scale of the IPO; IPO-
RT = Reality Testing scale of the IPO; IPO-AGG = Aggression scale of the IPO; IPO-MOR = Moral Functioning scale of the IPO. +/-LR = Positive/
Negative Likelihood Ratios; +/-PV = Positive/Negative Predictive Values.
43
Table 8
Cut-off scores for the Borderline PO based on the IPO scales.
Scale Criterion Sensitivity Specificity Youden's Index +LR -LR +PV -PV
IPO-PD
≥17 100.00 0.00 0.01 1.00 – 10.0 –
> 40 100.00 80.69 0.81 5.18 0.00 36.5 100.0
> 41 96.77 86.14 0.83 6.98 0.037 43.7 99.6
> 43 90.32 92.08 0.82 11.40 0.11 55.9 98.8
> 44 87.10 94.06 0.81 14.66 0.14 62.0 98.5
> 45 80.65 95.05 0.76 16.29 0.20 64.4 97.8
> 46 77.42 97.52 0.75 31.28 0.23 77.7 97.5
> 47 74.19 98.51 0.73 49.96 0.26 84.7 97.2
> 50 38.71 100.00 0.39 – 0.61 100.0 93.6
> 66 0.00 100.00 0.01 – 1.00 – 90.0
IPO-ID
≥43 100.00 0.00 0.01 1.00 – 10.0 –
> 81 100.00 78.71 0.79 4.70 0.00 34.3 100.0
> 82 96.77 80.69 0.77 5.01 0.040 35.8 99.6
> 83 90.32 83.66 0.74 5.53 0.12 38.1 98.7
> 84 90.32 87.62 0.78 7.30 0.11 44.8 98.8
> 85 87.10 89.60 0.77 8.38 0.14 48.2 98.4
> 86 83.87 91.58 0.75 9.97 0.18 52.5 98.1
> 87 77.42 93.07 0.70 11.17 0.24 55.4 97.4
> 95 45.16 100.00 0.45 – 0.55 100.0 94.3
> 118 0.00 100.00 0.03 – 1.00 – 90.0
IPO-RT
≥21 100.00 0.00 0.01 1.00 – 10.0 –
> 45 100.00 79.70 0.80 4.93 0.00 35.4 100.0
> 48 93.55 89.60 0.83 9.00 0.07 50.0 99.2
> 49 93.55 92.08 0.86 11.81 0.07 56.8 99.2
> 50 90.32 94.55 0.85 16.59 0.10 64.8 98.9
> 51 83.87 95.05 0.79 16.94 0.17 65.3 98.1
> 52 80.65 96.04 0.77 20.36 0.20 69.3 97.8
> 58 48.39 100.00 0.64 – 0.52 100.0 94.6
> 80 0.00 100.00 0.03 – 1.00 90.0
IPO-AGG
≥18 100.00 0.00 0.03 1.00 – 10.0 –
> 22 100.00 35.64 0.36 1.55 0.00 14.7 100.0
> 23 96.77 47.52 0.44 1.84 0.07 17.0 99.3
> 28 90.32 75.74 0.66 3.72 0.13 29.3 98.6
> 29 87.10 80.69 0.68 4.51 0.16 33.4 98.3
> 31 87.10 85.64 0.73 6.07 0.15 40.3 98.4
> 32 83.87 88.61 0.72 7.37 0.18 45.0 98.0
> 33 77.42 92.57 0.70 10.43 0.24 53.7 97.4
> 41 32.26 99.50 0.32 65.16 0.68 87.9 93.0
> 48 32.26 100.00 0.32 – 0.68 100.0 93.0
> 64 0.00 100.00 0.07 – 1.00 – 90.0
IPO-MOR
≥8 100.00 0.00 0.01 1.00 – 10.0 –
> 16 100.00 40.59 0.41 1.68 0.00 15.8 100.0
> 17 96.77 51.49 0.48 1.99 0.063 18.1 99.3
> 19 93.55 68.81 0.62 3.00 0.094 25.0 99.0
> 20 87.10 75.74 0.63 3.59 0.17 28.5 98.1
> 21 83.87 81.19 0.65 4.46 0.20 33.1 97.8
> 22 70.97 88.12 0.59 5.97 0.33 39.9 96.5
> 23 54.84 92.08 0.47 6.92 0.49 43.5 94.8
> 29 6.45 99.50 0.06 13.03 0.94 59.2 90.5
> 30 3.23 100.00 0.04 – 0.97 100.0 90.3
> 34 0.00 100.00 0.03 – 1.00 – 90.0
Note. IPO = Inventory of Personality Organization; IPO-PD = Primitive Defenses scale of the IPO; IPO-ID = Identity Diffusion scale of the IPO; IPO-
RT = Reality Testing scale of the IPO; IPO-AGG = Aggression scale of the IPO; IPO-MOR = Moral Functioning scale of the IPO. +/-LR = Positive/
Negative Likelihood Ratios; +/-PV = Positive/Negative Predictive Values.
Despite similarities between the results obtained from the cluster and q-factor analysis regarding the number of groups/clusters,
there were certain differences that provided additional information regarding the groups. For example, results from the second
analysis suggest that, in adolescents, unstable representations of self and others (i.e. identity impairment) may not only be specific to
Borderline PO, but may also be characteristic of both Neurotic and, to a lesser extent, Normal PO. Despite differing from the the-
oretical assumptions on this matter, with identity impairment being considered specific to individuals with a Borderline PO (Clarkin
et al., 2007a,b,c; Yeomans et al., 2015), these results are consistent with our recent findings suggesting that an unstable sense of self
44
and others appears to be more generalized in adolescents than in adults (Biberdzic et al., 2017). With adolescence being a crucial
period for the consolidation of identity and a period of rapid change, it is thus not surprising that adolescents with a Normal PO also
presented uncertain representations of others as well as somewhat fluctuant representations of self. However, as mentioned earlier,
adolescents with this type of PO had a stable overall sense of self as suggested by their capacity to keep long-term objectives and
commitments, and their more stable representations of others, unlike adolescents from the other two groups. This generalized
fluctuation regarding self representations is also consistent with other recent findings suggesting that identity issues are to be ex-
pected during adolescent development, and are however clearly distinguishable from identity disturbance in personality-disordered
adolescents (Feenstra, Hutsebaut, Verheul, & Van Limbeek, 2014; Goth et al., 2012). In comparison with the adolescents with a
Borderline PO, the Neurotic PO group was characterized by an excessive worry concerning the opinion of others (e.g. “I am not sure
what others think of me, even people who know me very well” or “When others see me as having succeeded, I'm delighted and, when
they see me as failing, I feel devastated”), whereas those in the Borderline PO group were more suspicious and distrusting of others
(e.g. “It is hard for me to trust people because they often turn against me or betray me” or “People I once thought highly of have
disappointed me by not living up to what I expected of them”). This is in line with the theoretical assumptions regarding higher
identity impairment in individuals with a Borderline PO (Clarkin et al., 2007a,b,c), and may also suggest that unstable re-
presentations of self and others in adolescents with a Neurotic PO are associated with a heightened sensitivity to the opinion of peers
and to a greater need (or pressure) for conformism. Further research in this direction is needed.
Nonetheless, findings from the q-factor analysis suggest that grandiose representations of self as well as impaired moral func-
tioning may be specific to adolescents with a Borderline PO. This is consistent with theoretical assumptions (Caligor & Clarkin, 2010),
as well as with our results from the cluster analysis suggesting that these adolescents present less internalized moral values, and
higher narcissistic and borderline traits than those with a Normal and Neurotic PO. These results are also consistent with a positive
correlation found in previous studies in adults between indicators of BPO and aggression, shame, and narcissism (Pincus et al., 2009).
We have recently suggested that a more narcissistic component may also be more specific to adolescent personality when compared
to that of adults (Biberdzic et al., 2017), and it is possible that higher rates of aggression and immature or poorer moral functioning
observed during this developmental period may contribute to the heightened narcissistic features observed during adolescence.
Alternatively, narcissism may also be activated by adolescents to surmount the multiple challenges they face during the transition to
young adulthood (e.g. achieving emotional independence from parents and others, accepting greater responsibilities, acquiring new
and more complex set of skills). It therefore remains unclear at this stage whether and when these narcissistic features are adaptive or
pathological. Finally, results from the second analysis also suggest that intact reality testing and low levels of aggression were
characteristic of all three levels of PO found in adolescents. This is to be expected considering the non-clinical sample of students used
in this study.
With regard to the second objective of this study, which was to further assess the utility of a dimensional and developmentally
sensitive assessment tool of personality functioning, preliminary cut-off points for each of the main dimensions of the IPO-A for
Normal, Neurotic, and Borderline PO, were successfully established. These promising findings have potentially important clinical
implications. Firstly, with the identification of preliminary cut-points, the IPO-A may prove to be a useful tool for screening per-
sonality pathology in non-clinical settings, and for identifying adolescents who present significant difficulties. Indeed, the IPO-A
provides a differentiated picture of the severity of personality pathology and allows dimensional ratings of several domains central to
personality functioning. The early identification and treatment of adolescents who present difficulties on specific indicators of pa-
thological PO may prevent the potential consolidation of these pathological personality features and processes. The present study is
also the first to address the challenge of establishing clinically relevant cut-off scores for the IPO and provides important information
for future comparative studies of adolescent and adult populations, suggesting that cut-points for the adult version of the IPO should
also be established. Furthermore, findings support the claims that important difficulties related to personality functioning are present
in adolescence, with 13–14% (according to the results of the cluster and q-factor analysis) of our sample being classified as having a
Borderline PO. Again, this is important considering that early maladaptive personality traits are predictive of less favorable devel-
opmental outcomes, including problems in areas such as school, work, peer and romantic relationships, and are the strongest pre-
dictors of future personality functioning (De Fruyt & De Clercq, 2014; Stepp, Pilkonis, Hipwell, Loeber, & Stouthamer-Loeber, 2010).
With growing evidence suggesting that personality pathology in adolescence is associated with a range of comorbid disorders (e.g.,
mood disorders and substance use disorders), psychosocial problems (Chanen, Jovev, & Jackson, 2007; Johnson, Chen, & Cohen,
2004), and high economic burden (Feenstra et al., 2012), early assessment of potential difficulties in personality functioning is
warranted. We believe that a dimensional approach that focuses on underlying personality functioning would allow the assessment of
personality pathology in its early stage of development, and that the PO framework is promising for a successful and developmentally
sensitive assessment. The merits of this framework in clinical work with adolescents presenting PDs have been previously docu-
mented (see e.g. Bleiberg, 2002), and it is no surprise that there is a renewed interest in clinical research related to the assessment and
treatment of PDs in adolescence within this framework (see Ammaniti, Fontana, & Nicolais, 2015; Ammaniti, Fontana, Clarkin,
Clarkin Nicolais, & Kernberg, 2012; Normandin, Ensink, & Kernberg, 2015; Normandin, Ensink, Yeomans, & Kernberg, 2014).
However, future research is needed to empirically translate the relevance of this model in useful assessment instruments that are
adapted to adolescents, and further testing of the IPO-A's relevance in adolescence is needed. As Debast, Rossi, Feenstra, and
Hutsebaut (2017) have recently suggested, a developmentally sensitive assessment instrument that is able to differentiate between
adolescent normative changes and expressions of personality pathology, would be ideal. The IPO-A may therefore require a closer
examination and potential addition of items in the near future that would encompass a wider (and more specific) range of personality
functioning in adolescents.
Some limitations of the present study also need to be mentioned. First, replication of the results with a larger sample including
45
more male participants would be beneficial. Also, future studies should try and establish cut-off scores for the IPO-A in clinical
settings. The replication of these findings among adolescents with different PDs would greatly benefit the clinical utility of the IPO-A.
Finally, and perhaps most importantly, the ROC curve analyses in this study were performed without an entirely “independent”
criterion per se. Since the groups were established following the results of the cluster analysis, patients identified as belonging to the
different groups on the basis of the cluster analysis identification may not necessarily be representative of the general “normal”,
“neurotic”, and “borderline” PO adolescent population. ROC curve analysis is usually used to assess the inherent validity of a di-
agnostic test by comparing it against a gold standard. Considering that there is no established gold standard when it comes to PO in
adolescents, this was not possible to do in the current study. However, future studies should further investigate the obtained
thresholds by comparing them with those of an external criterion such as the Interview of Personality Organization Processes in
Adolescence (IPOP-A; Ammaniti et al., 2012), for example.
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Empirical Typology

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Journal of Adolescence 66 (2018) 31–48

Contents lists available at ScienceDirect

Empirical typology of adolescent personality organization

The concept of personality organization (PO) is central to current psychodynamic understanding

2. Assessing personality organization

3. The current study

4.1. Participants and procedure

4.2.1. IPO-A (Biberdzic et al., 2013)

4.2.2. Self-Concept Clarity Scale (SCCS; Campbell et al., 1996)

consistency (Cronbach's α = .83).

4.2.5. State-Trait Anger Expression Inventory–2 (STAXI-2; Spielberger, 1999)

4.2.7. Pathological Narcissism Inventory (PNI; Pincus et al., 2009)

4.2.9. Youth Self-Report (YSR; Achenbach, 1991)

4.2.11. Dickman's Impulsivity Inventory (DII; Dickman, 1990)

shown adequate internal consistency in this study (Cronbach's α = .88).

4.2.14. Self-Perception Proﬁle for Adolescents (SPPA; Harter, 1988)

4.3. Statistical analyses

5.1. Two-step cluster analysis

5.2. Q-factor analysis

Q-factor 1 Q-factor 2 Q-factor 3

Q-factor 1 Q-factor 2 Q-factor 3

Q-factor 1 Q-factor 2 Q-factor 3

Normal PO (n = 184) Neurotic PO (n = 189) Borderline PO (n = 57)

Q-Factor Normal PO (n = 181) Neurotic PO (n = 196) Borderline PO (n = 53)

5.3. Establishing cut-oﬀ scores

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