The PersoniCAT Project

Background and Aims

The goal of this project was to develop an adaptive instrument for assessing personality disorders. Instruments that are currently in use are relatively cumbersome, and may be a challenge to use; especially for clinicians who do not use them on a daily basis.

The new instrument that we have developed is based on principles of computerized adaptive testing. This means that the instrument is governed by an algorithm and adapted real-time, so that only the questions that are relevant and contribute important information needed to make the diagnosis are selected. Using the adaptive algorithm allows for delivering a relatively short, yet precise, personalized test; while ensuring adequate content coverage.

The instrument was designed to be more intuitive to use than the current generation of semi-structured interviews. This facilitates assessment of personality disorders for clinicians who are not specialized in these disorders per se, such as clinicians working in remote areas. Since personality disorders are notoriously hard to treat, correct diagnosis is of paramount importance: using appropriate treatment designed especially for a particular personality disorder has been shown to help patients improve.

We have studied how the instruments that our adaptive test is based on are used in practice. Among other things, we explored how clinicians perceive the ease of use of these instruments, as well as their views on the advantages, disadvantages and challenges associated with using these instruments in clinical settings. We used this information in the development the prototype of our adaptive test, which was shown to clinicians and researchers at the national conference organized by the Network for Personality Disorders in 2022. Through this demonstration, we obtained input from the conference participants that was used to refine the adaptive test further. The test is accompanied by a scoring module that turns the test scores into graphical displays.

Based on a literature review and an experiment we did with experienced clinicians, we have developed a scoring module that promotes the correct interpretation of test results and their clinical implications.

Future plans

Our aim is to ask the American Psychiatric Association if they are interested in publishing the CAT interview. We also intend to apply for funding to test the interview in clinical settings.

Project group

Project coordinator

Muirne C. S. Paap, PhD, Researcher, Department of Research and Innovation, Clinic Mental Health and Addiction, Oslo University Hospital; and Associate Professor, Department of Child and Family Welfare, Faculty of Behavioural and Social Sciences, University of Groningen, The Netherlands. E-mail: m.c.s.paap@rug.nl

Team members

• Aleksander Heltne, PhD student, Department of Research and Innovation, Clinic Mental Health and Addiction, Oslo University Hospital.
• Sara Germans Selvik, PhD, Associate Professor, Department of Mental Health, NTNU, and psychiatrist and department manager at Namsos hospital.
• Benjamin Hummelen, PhD, psychiatrist and chief physician, Department of Research and Innovation, Clinic Mental Health and Addiction, Oslo University Hospital.
• Niek Frans, PhD, Assistant Professor, Department of Pedagogy, Faculty of Behavioural and Social Sciences, University of Groningen, The Netherlands.
• Johan Braeken, Professor, Center for Educational Measurement, University of Oslo.
• Christina Bode, Associate Professor, Department of Psychology, Health & Technology, Faculty of Behavioral Management and Social Science, University of Twente, The Netherlands.
• Bernard Veldkamp, Professor, Department of Learning Data and Technology, Faculty of Behavioral Management and Social Science, University of Twente, The Netherlands.
• Geir Pedersen, PhD, senior researcher, Oslo University Hospital.
• Erik Falkum, PhD, Professor Emeritus, University of Oslo.

Funding

The project was funded by the Norwegian Research Council (NOK 8 mill.). The funding by NFR was used to cover the costs for salary for a doctoral student, a postdoc (part-time), and two senior researchers (part-time).

Publications

• Paap, M. C. S., Heltne, A., Pedersen, G., Germans Selvik, S., Frans, N., Wilberg, T., & Hummelen, B. (2021). More is more: Evidence for the incremental value of the SCID-II/SCID-5-PD specific factors over and above a general personality disorder factor. Personality Disorders: Theory, Research, and Treatment. Advance online publication. https://doi.org/10.1037/per0000426

• Hummelen, B., Braeken, J., Buer Christensen, T., Nysaeter, T. E., Germans Selvik, S., Walther, K., Pedersen, G., Eikenaes, I., Paap, M. C. S. (2021). A Psychometric Analysis of the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders Module I (SCID-5-AMPD-I): Level of Personality Functioning Scale. Assessment. 2021;28(5):1320-1333. https://doi.org/10.1177/1073191120967972

• Heltne, A., Bode, C., Hummelen, B., Falkum, E., Germans Selvik, S., Paap, M. C. S. (2021). Norwegian Clinicians’ Experiences of Learnability and Usability of SCID-II, SCID-5-PD and SCID-5-AMPD-I Interviews: A Sequential Multi-Group Qualitative Approach. Journal of Personality Assessment: 1-14. https://doi.org/10.1080/00223891.2021.1975726

• Paap, M. C. S., Hummelen, B., Braeken, J., Arnevik, E. A., Walderhaug, E., Wilberg, T., Berghuis, H., Hutsebaut, J., & Pedersen, G. (2021). A multi-center psychometric evaluation of the Severity Indices of Personality Problems 118 (SIPP-118): Do we really need all those facets? Quality of Life Research, 30(2), 567-575. https://doi.org/10.1007/s11136-020-02654-8

• Braeken, J., & Paap, M. C. S. (2020). Making Fixed-Precision Between-Item Multidimensional Computerized Adaptive Tests Even Shorter by Reducing the Asymmetry Between Selection and Stopping Rules. Applied Psychological Measurement, 44(7-8), 531-547. https://doi.org/10.1177/0146621620932666