Characteristics, Uses, and Purpose of the PAI
The Personality Assessment Inventory (PAI) developed by Leslie Morey is a psychological assessment instrument used in assessing various psychological constructs related to personality and psychotherapy.
Additionally, considering that this inventory is a multi-scale assessment test, in the recent past, PAI has found various contextual applications such as psychopathology evaluation, psychotherapy evaluation, forensic activities, and child custody assessment exercises.
Accordingly, PAI has a number of characteristics, for instance, the instrument consists of 344 items and 22 non-overlapping full scales, which allow researchers to assess various psychopathology dimensions in adults aged 18 years and above.
Therefore, PAI contains 11 clinical scales covering psychiatric diagnosis, five treatment assessment scales corresponding to evaluation of factors and risk factors in the development of clinical disorders, four validity scales whose purpose is to assess the approach used by participants in responding to other PAI measures, and two interpersonal scales that indicate the interpersonal relationships underlying personality in the respondents (Hersen, 2004, pp. 1-16).
On the other hand, PAI is developed and standardized on the basis of a sample population consisting of adults aged 18 years and above. Additionally, the reading level of PAI corresponds to the 4th Grade of education, and thus, depending on the respondent’s skills and competence, the minimum amount of time required to complete the test is about 50 minutes.
The instrument is also relatively easy to administer implying that technicians with basic knowledge in administering self-reporting tests can find it easy to use. Furthermore, to ensure that follow-up questioning is achieved, the PAI contains about 27 critical items for that purpose.
Overall, the purpose of the PAI is to enable employers to assess mental health problems involving applicants for different job positions, including plant operators, pilots, and positions, which require individuals with high standards of group performance and interpersonal skills.
Conversely, PAI is also instrumental in assessing sexual abuse tendencies and aggressiveness in babysitters and child caregivers; paranoia, suicidal ideation, and depressive disorders in pilots and plant operators (Hersen, 2004, pp. 1-16).
In this critique, the theoretical basis, practical applications, psychometric properties, reliability, and ethical considerations of the PAI are considered relative to the instrument’s application in Post-traumatic Stress Disorder (PTSD) cases.
The relationship between PAI and the Interpersonal theory of personality
Part of the scales measured by PAI includes the interpersonal scales, which assess the ability of an individual to control, support, and remain independent in interpersonal relationships. These interpersonal scales include Dominance (DOM) and Warmth (WRM), which according to Hersen (2004, p. 16), are based on the interpersonal theory of personality.
According to this theory, psychopathology across different cultural set-ups can be assessed through two major personality traits or dimensions, that is, internalization and externalization. Here, internalization refers to instances whereby an individual involved in an interpersonal relationship is made to feel bad by the other party.
Conversely, externalization involves actions of one party making the other party feel bad in a personal relationship. The theory then goes ahead to show that interpersonal relationships are defined and bound by affective and behavioral dispositions.
Therefore, many psychopathological disorders arise as a result of extreme manifestation of these otherwise normal personality dimensions or traits. It then follows that the PAI emphasizes the theoretical framework/literature of the interpersonal theory of personality particularly in item selection and scale development.
A summary of research findings
In the recent past, the PAI has found application in the assessment, diagnosis, and discrimination of various psychopathological disorders, including the Post-traumatic Stress Disorder (PTSD). Studies note that proper assessment of PTSD needs to take into consideration various critical measurements such as traumatic events, multiple scales of the disorder, personality scales, and broad-based symptoms (Calhoun, 2009, p. 409).
These measurements should also include the appropriate administration of structured diagnostic interviews. Here, all possibilities point to the application of the PAI as the most appropriate instrument to assess the above-mentioned measures. In a study aimed at investigating the efficiency of the PAI in diagnosing PTSD in women, Calhoun and others examined a community-based sample consisting of 128 women.
The study utilizes Receiver Operating Curves (ROC) in examining the effectiveness of the PAI LOGIT function in PTSD diagnosis. As a result, the researchers found out that relative to the clinician-administered PTSD scales, the PAI gave promising results with the Area under the Curve (AUC) equaling to 0.856 and the Standard Error (S.E.) being 0.034.
The results are consistent with most other PTSD scales, such as the Davidson Trauma Scale (DTS). Consequently, there is evidence to suggest that the PAI is a useful and more effective means of assessing PTSD.
Furthermore, additional studies under the current investigation note that the sensitivity and specificity of the PAI in discriminating between cases of PTSD from the rest of the population is 0.83 and 1.0 respectively (Calhoun, 2009, p. 412).
In yet another study aimed at investigating the different types of trauma, Ingram (2008, p. 4) notes that PTSD being a collective term used to refer to a host other related traumatic symptoms; there is the need to investigate the contribution of different trauma symptoms in the eventual manifestation of PTSD.
The use of a multi-scale test that corresponds to DSM qualifies as the most effective tool upon which this investigation should be based. Here, the researcher used the PAI to assess and discriminate between three major types of trauma, including motor-vehicle accident, sexual assault, and the sudden death of a close relative.
The study, which involves participants drawn from Auburn University student community, examines the individual profiles of the respondents relative to the PAI scales. As a result, the study notes that sexual assault produces severe PTSD symptoms, with major differences occurring in the way the three groups respond to different types of trauma.
Here, the result shows that the three different types of trauma are distinct to one another, and thus, the overall PTSD symptoms related to these trauma types are also various (Ingram, 2008, pp. 15-25). This is a clear indication that PTSD is in need of differential diagnosis and treatment in order to satisfy the needs of different patients experiencing different trauma types.
The sensitivity of the PAI in discriminating between the three types of trauma lies on the fact that the instrument’s items are distinct, they do not overlap, and each item corresponds to specific psychological constructs for which it is designed to measure.
Therefore, an exclusion criterion is followed in the selection of respondents through the validity scales to discriminate between those who qualify to take the test and the general population.
On the other hand, it is worth noting that the PAI scales cover two very important personality dimensions, which include the Aggression scale (AGG) and the Violence Potential Index (VPI).
As noted earlier, these scales provide essential insights into the behavioral patterns and interpersonal qualities that inform the appointment of individuals into various positions, such as social workers, babysitters, and childcare workers. However, these scales are also imperative in assessing the behavioral patterns of veterans before they are accepted into the community.
As a result, Eric Crawford and others took time to examine the validity of the two scales in their application on veterans diagnosed with PTSD (Crawford, 2007, p. 90). In their study, the researchers examined 399 male combat veterans through the normal process of evaluating PTSD using the PAI scales.
The results note that the PAI Aggression (AGG) scales correspond to other forms of hostility and violence measurements and that the AGG scale shows discriminant validity compared to other alternative measures.
Furthermore, cases of interpersonal hostility and violence among the respondents were assessed using the AGG composite scale, which is incrementally valid as opposed to other measures such as PTSD severity scale and MMPI-2 scale in measuring aggression tendencies (Crawford, 2007, p. 95).
From the study findings, it is apparent that the PAI scales are more sensitive and effective in assessing certain psychological constructs when compared to other instruments.
The psychometric properties of PAI for PTSD cases
From the aforementioned characteristics of PAI, it is apparent that the PAI is appropriate and applicable for individuals aged 18 years and above because the complexity and ease of understanding the content presented in the instrument befits adults. Furthermore, the PAI items are written and presented in such a way that individuals from different cultural set-ups can understand them more easily.
The instrument takes into consideration the education levels of most citizens in the U.S. and across the world, considering that it is written at a fourth-grade reading level, which is the lowest when compared to other instruments meant for the same purpose and population (Hersen, 2004, pp. 18-19).
Moreover, considering that the PAI scales and corresponding sub-scales represent a mean score of 50 and standard deviation (S.D.) of 10 during the initial development and standardization stages, there is reason enough to suggest that the PAI matches the gender, age, race, and education abilities of most individuals experiencing PTSD in the U.S. and other parts of the world.
The gender insensitivity demonstrated in calculating T-scores for the PAI scales and sub-scales corresponds to current studies, which have not recorded any significant bias in the way males and females respond to PTSD (Hersen, 2004, p. 20).
In as far as construct validity is concerned, most PAI scales converge with most symptoms presented by PTSD cases. Here, relative to the validity scales, interpersonal scales, treatment consideration scales, and clinical scales, the PAI is developed in such a way that individual items contain corresponding random responses, which can guide researchers in identifying inconsistencies in the way respondents approach the test.
The test is also validated in such a way that a researcher can discriminate between respondents trying to create a positive or negative impression in their response styles. Here, the instrument allows one to compare profiles generated from normal participants, clinical respondents (PTSD victims), and their respective response style simulations.
As a result, the instrument allows scoring to be graded into Negative Impression (NIM) and Positive Impression (PIM), and thus, malingering respondents are easily differentiated from the clinical sample (Hersen, 2004, p. 21).
Conclusions
From the foregoing discussions, it is certain that the applicability of the Personality Assessment Inventory (PAI) in diagnosing PTSD cases is adequate for individuals aged 18 years and above. However, it is also true that the PAI cannot be used to interpret data involving adolescents experiencing symptoms of PTSD.
Furthermore, the discussions note that the applicability of the PAI lies on its ability to provide insights into psychopathological screening, clinical diagnoses, and treatment plans. On the other hand, studies note that effective diagnosis of PTSD should include assessment of normal personality dimensions relative to extreme manifestations of the same (Hersen, 2004, p. 22).
Unfortunately, the PAI lacks essential mechanisms that can be employed in assessing the normal personality dispositions. Moreover, education scholars note that many individuals are capable of reading at levels, which are normally below their level or grade of education.
Thus, assumptions that people who have completed the fourth grade of education and above are capable of understanding the PAI, may be misleading and unreliable. Therefore, to ensure that all the respondents are at bar, there is the need to administer a pre-PAI reading and comprehension test before administering the main test (Hersen, 2004, p. 23).
Furthermore, it is obvious that some PTSD victims may be suffering from compromised cognitive ability during the process of PAI administration due to various emotional challenges. This group of respondents has been shown to exhibit high levels of NIM and PAI profile distortions. As a result, the cognitive abilities and mental state of the participants should also be a major consideration before administering the test.
Overall, considering the above-mentioned limitations, there is the need to base diagnostic and treatment decisions on both the PAI results and other information sources, including case histories, mental health exams, and neurophysiologic inventories, among others (Hersen, 2004, p. 24).
Conversely, the main legal and ethical considerations regarding PAI include the provisions of the Code of Conduct for psychologists, which dictate that all assessment instruments are administered by qualified and trained personnel.
Additionally, the PAI administration personnel should be acquitted with the relevant reliability, standardization, and validity information regarding the test.
Before reaching a conclusive diagnostic decision, the PAI scores should be treated as one part of the information sources, and thus other sources should be consulted before reaching the final decision. Client confidentiality and privacy regarding the information divulged through the PAI should be highly guaranteed in the same way other medical records are treated (Hersen, 2004, p. 24).
References
Calhoun, P. S., Christina, D. B., Crawford, E. F., & Beckham, J. C. (2009). Diagnostic efficiency of the Personality Assessment Inventory LOGIT Function for Post-traumatic Stress Disorder in women. J. Pers Assess., 91 (5), 409-415. Web.
Crawford, E. F., Calhoun, P. S., Braxton, L. E., & Beckham, J. C. (2007). Validity of the Personality Assessment Inventory Aggression Scales and Violence Potential Index in veterans with PTSD. J. Pers Assess., 88 (1), 90-98. Web.
Hersen, M. (2004). Comprehensive handbook of psychological assessment: Personality assessment. Hoboken, N. J.: John Wiley & Sons. Web.
Ingram, L. D. (2008). Investigation of trauma type differences using the Personality Assessment Inventory. Auburn, Alabama: Auburn University. Web.