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Criterion validity and psychometric properties of the affect intensity measure in a psychiatric sample
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i,di\x/. /Xtf. Vol. 19. No. 4. pp. SXS-SY I. 1995 Elwvier Science Lid. Printed in Grra~ Britam
CRITERION VALIDITY AND PSYCHOMETRIC PROPERTIES OF THE AFFECT INTENSITY MEASURE IN A PSYCHIATRIC SAMPLE Gordon L. Flett’,’ and Paul L. Hewitt’ ‘Department of Psychology, York University, 4700 Canada M3J IP3 and - University of British Columbia,
Keele Street, North York, Ontario, Vancouver, British Columbia, Canada
Summary-Recent research has confirmed the presence of individual differences in dispositional levels of affect intensity as assessed by the Affect Intensity Measure (AIM). At present, research with the AIM has focused exclusively on subclinical samples. In the present study, we conducted an initial examination of the clinical relevance of affect intensity by assessing the criterion validity of the AIM in a psychiatric sample. A total of 61 psychiatric patients (3 I men, 30 women) were administered the AIM and the Millon Clinical Multiaxial Inventory. Evidence of the AIM’s criterion validity was obtained in that affect intensity was correlated positively with indices of borderline personality and passive-aggressive personality, and it was correlated negatively with compulsive+zonforming personality. In addition, affect intensity was associated signiticantly with numerous symptom measures of poor adjustment including somatoform symptoms, hypomania, alcohol abuse, and psychotic thinking. The results are discussed in terms of the clinical usefulness of assessing affect intensity in dysfunctional personality styles and other forms of psychopathology.
A recent development in the emotion literature is the recognition that there are consistent individual differences in levels of response intensity, and these individual differences predict a variety of phenomena. Larsen and Diener (1987) developed the Affect Intensity Measure (AIM) in order to measure the response intensity with which individuals typically experience positive and negative emotions. Respondents to the AIM are asked to indicate the extent of their agreement with statements such as “My happy moods are so strong that I feel like I’m in heaven” and “When I do something wrong I have strong feelings of shame and guilt.” Existing evidence suggests that the affect intensity construct has many potential research applications. For instance, dispositional levels of affect intensity, as assessed by the AIM, reliably predict cognitive appraisals of emotions (Dritschel & Teasdale, 199 1; Flett, Boase, McAndrews, Phner & Blankstein, 1986a; Larsen, Diener & Cropanzano, 1987) subjective reactions to life stress (Larsen, Diener & Emmons, 1986), styles of emotional expression (Flett, Bator & Blankstein, 1988), interpersonal reactions (Blankstein, Flett, Koledin & Bortolotto. 1989; Larsen & Diener, 1987) physiological reactions (Larsen & Diener, 1987) and perceptions of physiological reactions (Blascovich, Brennen, Tomaka, Kelsey, Hughes, Coad & Adlin, 1992). On the basis of this evidence, it has been concluded that affect intensity, as measured by the AIM, is an important aspect of temperament in adults (see Strelau, 1991). Since the AIM is a relatively new measure, many important issues involving the scale remain to be tested. Unfortunately, almost all of existing research with this instrument thus far has limited its focus to the study of the correlates of the AIM in subclinical samples of college students. The purpose of the present study was to assess the association between the AIM and indices of psychopathology in a clinical sample. Consistent with the general emphasis on the importance of affect in psychotherapy (Greenberg, Elliott & Foerster, 1990; Greenberg & Safran, 1987), a survey of the available literature on personal adjustment suggests that affect intensity may be particularly important in the experience of various forms of maladjustment. For instance, extant descriptions of personality disorders (e.g. American Psychiatric Association, 1987; Millon, 198 1) include descriptions of certain individuals who experience their affect with great intensity. Passive-aggressive personalities, for instance, have been described in the following manner: “Many are excitable and impulsive. Others suddenly burst into tears and guilt at the slightest upset. Still others often discharge anger or abuse at the least of *Address reprint requests to: Gordon L. Flett. Department Ontario, Canada
of Psychology.
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York University,
4700 Keele Street, North York.
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Gordon L. Flett and Paul L. Hewitt
provocations. The impulsive, unpredictable, and often explosive reactions of these personalities make it difficult for others to feel comfortable in their presence...” (Millon, 1981, p. 254). Similarly, the borderline personality has been described as experiencing intense affect. According to published reports, this affect is experienced often in the form of extreme anger directed toward others (Davis & Akiskal, 1986; Gunderson, 1984; Perry & Klerman, 1980; Snyder & Pitt, 1985) along with a great deal of conflict associated with the expression of this intense anger (Perry & Cooper, 1986). However, consistent with the definition of the affect intensity construct, borderline individuals have also been described as being characterized by intense feelings of such positive emotions as euphoria and excitement (Millon, 1981). Whereas the above personality disorders are believed to include intense affect, other personality disorders are believed to be characterized by extremely mild affect. The schizotypal personality, for instance, has been referred to as almost lacking affect entirely, even in situations that require an emotional response of some intensity (American Psychiatric Association, 1987). Likewise, the compulsive personality has been described as having restrained affectivity and little emotional expression (American Psychiatric Association, 1987; Goldstein, 1985; Pollak, 1987). In addition to the possible link between affect intensity and indices of Axis II personality disorders, it is likely that affect intensity is associated with other forms of maladjustment involving Axis I disorders such as depression and anxiety. Larsen and Diener (1987) have reported evidence indicating that greater affect intensity is associated with a measure of risk for bipolar illness in college students. They have also found that affect intensity is associated with indices of somatic and neurotic symptoms. Likewise, Williams (1989) and Dritschel and Teasdale (1991) reported a significant positive relation between affect intensity and neuroticism, while Dance, Kuiper and Martin (1990) reported a positive association between affect intensity and dysfunctional attitudes. Although these findings suggest that affect intensity is associated widely with a variety of adjustment problems, it should be reiterated that these data were obtained from nonclinical samples. Thus, the link between affect intensity and indices of psychopathology remains to be explored in psychiatric patients. Consequently, the main purpose of the present study was to examine the criterion validity of the AIM by testing the general hypothesis that individual differences in affect intensity are associated with measures of psychopathology in clinical patients. A sample of unselected psychiatric patients completed the AIM and the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983) a well-known psychodiagnostic measure of personality dysfunction. The MCMI provides indices of various personality disorders as well as symptom measures of a variety of other adjustment difficulties involving Axis- I diagnoses, including hypomania, alcohol abuse, and psychotic reactions. Consequently, the use of the MCMI in the present study enabled us to determine the extent to which affect intensity is associated broadly with indices of psychopathology in a clinical sample. In addition, a secondary goal of this research was to examine the psychometric properties of the AIM in a clinical sample. Psychometric data are also reported below.
METHOD Subjects
The participants were 61 psychiatric patients (31 men, 30 women) from Brockville Psychiatric Hospital. The sample consisted of 27 inpatients and 34 outpatients with a variety of DSM-III-R diagnoses as determined by their respective clinicians. For instance, approximately 37% of the Ss were diagnosed as schnizophrenic, while 21% had a primary diagnosis of major depressive disorder, and 11% had some type of personality disorder. The remaining patients had a widespread variety of diagnoses including adjustment reaction, alcohol-drug dependence, and anxiety disorder, although patients with organicity were not included. The mean age of the Ss was 35.19 yr (SD = 10.36) with the ages ranging from 16 yr to 58 yr. All Ss had at least a grade eight education. The Ss were tested individually and paid 10 dollars for their participation. Materials and procedures Ss completed the AIM and the MCMI in a counterbalanced order. The AIM is a 40-item scale designed to measure the intensity with which individuals typically experience positive and negative
Validity of the Affect Intensity Measure
587
emotions. Respondents are asked to make six-point ratings of the extent of their agreement with such statements as “When I do something wrong I have strong feelings of shame and guilt” and “When I accomplish something difficult I feel delighted or elated.” The AIM consists of reactions to both positive and negative emotions and several items are reverse-keyed. A growing number of studies have attested to both the reliability and validity of the affect intensity construct as assessed by this instrument (Flett Blankstein, Bator & Pliner, 1989; Flett, Boase, McAndrews; Blankstein & Pliner, 1986b; Goldsmith & Walters, 1989; Larsen & Diener, 1985, 1987). The MCMI is a 175-item true-false instrument that contains 20 scales relevant to DSM-III (American Psychiatric Association, 1980). It provides subscale scores of relatively mild personality disorders (i.e. schizoid-asocial, avoidant, dependent-submissive, histrionic-gregarious, narcissistic, antisocial-aggressive, compulsive-conforming and passive-aggressive) as well as more severe personality disorders (i.e. schizotypal, borderline and paranoid). It also provides a number of other symptom-related subscales (i.e. anxiety, somatoform, hypomania, dysthymia, alcohol abuse, drug abuse potential, psychotic thinking, psychotic depression and psychotic delusion). There is evidence of the MCMI’s concurrent validity (Gibertini, Brandenburg & Retzlaff, 1986; McMahon & Davidson, 1986; Millon, 1983), face validity (Moreland & Onstad, 1987), and stability (Choca, Peterson & Shanley, 1986; McMahon, Flynn & Davidson, 1985; Piersma, 1986) in a variety of populations. Thus, it was deemed suitable for the purposes of the present study.*
RESULTS
The mean AIM score for the sample as a whole was 152.21 (SD = 22.65) with an internal consistency alpha of 0.84. AIM score did not differ significantly as a function of inpatient-outpatient status. An analysis of variance did yield a significant gender difference, F (1, 59) = 4.84, P < 0.05. Consistent with other research, women reported higher AIM scores. The respective means for women and men were 158.50 (SD = 23.24) and 146.13 (SD = 20.65). Pearson product-moment correlations were computed between the AIM and the MCMI measures for the sample as a whole. The results are displayed in Table 1. Significant correlations were obtained between the AIM and the MCMI personality disorder measures of compulsive-conforming personality, r = - 0.35, P -=c 0.01, passive-aggressive personality, r = 0.3 1, P < 0.05, and borderline personality, r = 0.3 1, P < 0.05. That is, while extremely low affect intensity was associated with a compulsive-conforming personality, high affect intensity was associated with passive-aggressive and borderline tendencies. Affect intensity was not correlated significantly with other personality disorder measures in the total sample. In addition, the AIM was correlated significantly with MCMI symptom indices of hypomania, r = 0.29, P < 0.05, somatoform symptoms, r = 0.29, P < 0.05, alcohol abuse, r = 0.28, P < 0.05, psychotic thinking, r = 0.28, P < 0.05, and psychotic delusion, r = 0.25, P < 0.05. Marginally significant correlations were obtained between the AIM and measures of drug abuse potential, r = 0.23, P < 0.10, and psychotic depression, r = 0.23, P < 0.10. Correlations were computed separately for males and females. These results are also shown in Table 1. It can be seen that most of the correlations between the AIM and the MCMI personality disorder measures were not significantly different between males and females. For instance, the correlations were - 0.32 and - 0.30 between the AIM and the MCMI compulsive-conforming subscale for males and females, respectively. However, some gender differences did emerge. Affect intensity was correlated significantly with paranoid personality disorder in males, r= 0.58, PCO.05,but these measures were not correlated significantly in females, r = - 0.04, ns. Similarly, the AIM was correlated with psychotic thinking, r = 0.40, P < 0.IO,and psychotic delusion, r = 0.53, P < 0.01, in males. However, the same variables were not correlated significantly in females. These findings suggest the importance of examining separately the results for males and females in future research of this nature. *Most importantly, a closer examination of the MCMI item content revealed no items that directly involved affect intensity judgements. Consequently, it is unlikely that the subsequent results merely reflected overlap in the content of the MCMI and the AIM.
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L. Flett and Paul L. Hewitt
Table I. Correlations between the AIM and MCMI MCMI
measure
Total
Pmonnli~ disorder men~ures Schizoid-asocial Avoidant Dependent-submissive Histrionic-gregarious Narcissistic Antisocial-aggressive Comou I sive*onforminz Pas&e-aggressive Schizotypal Borderline-Cycloid Paranoid slwlprorncrtcdo~~ n,e‘,su)Y Anxiety Somatoform Hypomania Dysthymia Alcohol abuse Drug abuse potential Psychotic thinking Psychotic depression Psychotic delusion Note. ***P
**p
measures
Males
Females
0.08 0.20 0.17 - 0.1 1 - 0.03 0.1 I - 0.35*** 0.31** 0.04 0.31** 0.15
- 0.01 0.17 0.30 0.18 0.23 0.27 - 0.32* 0.18 0.26 0.27 0.58**
-0.01 0.08 0.02 -0.14 - 0.07 0.1 I - 0.30 0.30 - 0.19 0.18 - 0.04
0.13 0.29** 0.29** 0.17 0.28** 0.23* 0.28*’ 0.23* 0.25**
- 0.08 0.28 0.44* 0.00 0.24 0.45* 0.40* 0.24 0.53**
0. I3 0.14 O.IY 0.15 0.30* 0.23 0.02 0.02 0.02
*P
DISCUSSION The purpose of the present study was to examine the criterion validity of the AIM by investigating the link between stable individual differences in affect intensity and a self-report measure of psychopathology in a clinical sample. Overall, the analyses provided initial evidence of the criterion validity of the AIM in psychiatric patients. Our results indicated that a dispositional tendency to experience intense affect was associated significantly with the presence of a personality style typified by passive-aggressive and borderline characteristics. In contrast, a dispositional tendency to experience extremely low levels of affect intensity was correlated significantly with a compulsiveconforming personality. Thus, these data are generally consistent with reports suggesting that individuals with personality disorders such as borderline personality disorder are high in affect intensity while individuals with personality disorders such as compulsive personality disorder suffer from constricted affect. Overall, these data suggest that individual differences in affect intensity may contribute to various forms of psychopathology and the AIM may be a useful measure when assessing personality dysfunction. Although the data indicated a general association with personality disorder indices, affect intensity was not correlated significantly with other personality disorder subscales in the dramatic cluster which, on the surface, seemingly involve a high level of emotional response intensity. Individuals with the histrionic personality, for example, are described as manifesting short-lived, dramatic displays of affect (American Psychiatric Association, 1987). Why then was affect intensity not correlated significantly with the corresponding MCMI histrionic personality subscale? One possibility is that certain disorders within the dramatic cluster are characterized by emotional lability rather than affect intensity per se. That is, these disorders may be characterized more by variable emotional states that may or may not be experienced at an extreme level of intensity. It has been suggested elsewhere that affect intensity and affect lability may indeed be somewhat independent (Harvey, Greenberg & Set-per, 1989). Thus, future research in this area should examine both affect intensity and affect lability in order to obtain a more complete understanding of the role in psychopathology of trait-related differences in affectivity. A related goal of the present study was to further examine the criterion validity issue by investigating the link between affect intensity and specific psychological symptoms that reflect Axis I disorders. The findings involving the MCMI symptom subscales extended past research by showing that affect intensity was associated with a variety of severe psychological symptoms including hypomania, sonatoform disorder, psychotic thinking, and alcohol abuse in this clinical sample of psychiatric patients. The link between affect intensity and hypomania is consistent with past indications of an
Validity of the Affect Intensity Measure
589
association between affect intensity and symptoms of bipolar depression in college students (Larsen & Diener, 1987). Similarly, the association between affect intensity and somatoform symptoms is consistent with past research with college students (Larsen & Diener, 1987) and may reflect an association between affect intensity and a tendency to experience psychosomatic symptoms. The link between affect intensity and health outcomes is an important avenue for further research. Finally, the obtained link in the present study between affect intensity and alcohol abuse was not unexpected, in that affect intensity is associated with higher self-consciousness (Flett et al., 1986) and a great deal of research has demonstrated the role of chronic self-focused attention in alcoholism (Hull & Young, 1983; Hull, Young & Jouriles, 1986). Clearly, each one of the current findings needs to be replicated. However, on the basis of the current results, it does seem reasonable to conclude that the affect intensity construct is a relevant variable to study in clinical samples and it may be involved in various forms of psychopathology. Clearly, the present findings have several practical and theoretical implications. For instance, at the practical level, the results involving the personality disorder measures suggest that a consideration of affect intensity may be particularly useful in the classification and differential diagnosis of personality disorders. The fact that affect intensity was not correlated significantly with every measure of personality disorder in the present study suggests that a determination of levels of this personality trait may enable clinicians to make important discriminations among the various personality disorders. At the theoretical level, the current findings underscore the need for comprehensive models of psychopathology that incorporate individual differences in affect intensity. A growing literature on affect intensity has provided numerous findings that must be incorporated into future models. For instance in a recent study, Fujita Diener and Sandvik (1991) examined gender differences in affect intensity and well-being in college students. Fujita et ul. (1991) analyzed multiple measures of affect intensity and hedonic level. They concluded that women and men are equally happy despite the fact that women experience more intense negative affect, in part because women’s intense positive emotions tend to balance their intense negative emotions. This suggests that people with high affect intensity are not necessarily prone to poor personal adjustment because intense negative emotions may be offset by intense positive emotions and experiences. However, the current findings with psychiatric patients suggest that affect intensity is associated with symptoms of psychopathology for certain individuals who may be less likely to experience positive events. Theoretical explanations must identify the variables that combine with affect intensity to produce maladjustment. Perhaps affect intensity operates as a diathesis factor that must be experienced in conjunction with other factors such as low social support. Similar sequences have been proposed for other personality variables involved in psychopathology (see Hewitt & Flett, 1991). Clearly. there is need for theoretical models of adjustment that examine affect intensity within the context of other variables or processes. Regarding these future models, one focus of likely importance is the association between affect intensity and cognitive processing. Existing research indicates the individuals with high levels of affect intensity may have more vivid and intense autobiographical memories (Flett et al., 1986a; Fujita rt ul., 199 I ). Also, research suggests that high AIM scorers engage in the cognitive operations that are believed to contribute to bouts of depression (see Dritschel & Teasdale, 199 I ; Larsen et al., 1987). These findings with cognitive variables may provide the basis for elaborate models of affect intensity and personal maladjustment that focus on information processing. Although the present study has demonstrated the potential usefulness of the affect intensity variable among individuals characterized by severe dysfunction, it is evident that many questions remain to be answered. Future research must address several issues related to psychopathology. For instance, Larsen and Diener (1987) stated that individuals have dispositional levels of intense affect irrespective of the valence of affect. The results of several studies support this claim (e.g., Diener rt al., 1985; Flett ef Cal., 1986a). On the other hand, it is well-known clinically that individuals with severe levels of depression, for example, experience negative or aversive affect states very intensely, whereas more positive affect states are often not experienced at all. Some authors have suggested that the absence of positive affect is the defining feature of depression that distinguishes it from anxiety (Clark & Watson, 199 1). In light of this observation, it would be interesting to examine individual differences in affect intensity for positive vs negative affect states in clinically depressed Ss. One might expect that the intensity of experienced affect would differ greatly depending on whether a positive or a negative affect state is present in these Ss.
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The limitations of the current study should be acknowledged. First, it must be reiterated that our findings were based on an unselected psychiatric sample. It is important that future research examines levels of affect intensity and related psychometric properties of the AIM in groups of Ss with specific diagnoses because the use of a heterogenous sample may have obscured some important relations in the present study. Initial data relevant to this issue are promising and indicate a link between affect intensity and certain diagnoses, including personality disorders. For instance, in a recent unpublished study, we compared Ss with a diagnosis of either borderline personality disorder, major depressive disorder, adjustment disorder, or schizophrenia. There were 13 patients in each group. We found that significantly higher AIM scores were reported by the patients with either a major depressive disorder (M = 169.85, SD = 22.53) or a borderline personality disorder (M = 165.38, SD = 22.59), vs those patients with a diagnosis of either an adjustment disorder (M = 152.59, SD = 9.94) or schizophrenia (M = 150.08, SD = 21.65). The finding that elevated levels of affect intensity were present among those patients with a diagnosis of borderline personality disorder is consistent with the results of the current study. The other main limitation of the current study involves its cross-sectional nature. The methodology of the current study permits a test of the criterion validity of the AIM, but it does not enable us to make any statements about the possible role of affect intensity in vulnerability to certain personality disorders. It is important that future research examines affect intensity and psychopathology in a prospective design. It is particularly important to determine whether AIM scores remain elevated among those Ss whose symptoms abate. These limitations notwithstanding, the results of the present study provided initial support for the criterion validity of the AIM when administered to psychiatric patients. The results confirmed that affect intensity, as assessed by the AIM, is associated significantly with certain personality disorder indices and it is correlated with several MCMI clinical symptom scales. Overall, these data indicate the need to examine affect intensity in severe forms of maladjustment. It is our hope that the current research will serve as further impetus for research and theory on the role of affect intensity in severe forms of psychopathology.
AcknoMle~l~smlrrl~.s-This research was conducted while the second author was at Brockville Psychiatric Hospital. This research was supported in part by a grant awarded to the authors by the Research and Program Evaluation Committee, Brockville Psychiatric Hospital, as well as a Social Sciences and Humanities Research Council of Canada Research Fellowship awarded to the first author. The authors wish to thank Wendy Tumbull and Marjorie Cousins for their help in gathering the data. Requests for reprints should be addressed to Gordon Flett, York University, Dept. of Psychology, 4700 Keele Street, North York, Ontario, M3J I P3, Canada.
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of the Affect
Intensity
Measure
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Flett, G. L., Boase. P., McAndrews, M. P., Pliner, P. & Blankstein, K. P. (1986a). Affect intensity and the appraisal of emotion. Journal ofResearch in Personality, 20, 447-459. Flett, G. L., Boase, P., McAndrews, M. P., Blankstein, K. R. & Pliner, P. (1986b). Affect intensity and self-consciousness in college students. Psyhological Reports, 56. 148-150. Fujita, F., Diener, E. & Sandvik, E. (1991). Gender differences in negative affect and well-being: The case for emotional intensity. Journal of Personality and Social Psycho1oS.v. 61, 427-434. Gibertini, M., Brandenburg, N. & Retzlaff, P. (1986). The operating characteristics of the Millon Clinical Multiaxial Inventory. Journal of Personality Assessment, SO, 554-567. Goldsmith. R. E. & Walters, H. (1989). A validity study of the Affect Intensity Measure. Jaurnal of Social Behavior and Personality. 4, 133-140. Goldstein, W. N. (1985). Obsessive-compulsive behavior, DSM-III, and a psychodynamic classification of psychopathology. American Journal af Psychotherapy, 33, 346-359. Greenberg, L. S. & Safran, J. (1987). Emotion in psychotherapy: AfSect and cognition in the process ofchange. New York: Guilford. Greenberg, L. S., Elliott, R. K. & Foerster, F. S. (1990). Experiential processes in the psychotherapeutic treatment of depression. In McCann, C. D. & EndIer, N. S. (Eds). Depression: New directions in theoty research, and practice (pp. 157-l 85). Toronto: Wall and Emerson. Gunderson, J. G. (1984). Borderline Personality disorder. Washington, DC: American Psychiatric Association. Harvey, P. D., Greenberg, B. R. & Serper, M. R. (1989). The Affective Lability Scales: Development, reliability, and validity. Journal of Clinical Psyholagy. 45, 786-793. Hewitt, P. L. & Flett, G. L. ( 1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psvcholagy, 60, 456-470. Hull, J. G. & Young, R. D. (1983). 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i,di\x/. /Xtf. Vol. 19. No. 4. pp. SXS-SY I. 1995 Elwvier Science Lid. Printed in Grra~ Britam
CRITERION VALIDITY AND PSYCHOMETRIC PROPERTIES OF THE AFFECT INTENSITY MEASURE IN A PSYCHIATRIC SAMPLE Gordon L. Flett’,’ and Paul L. Hewitt’ ‘Department of Psychology, York University, 4700 Canada M3J IP3 and - University of British Columbia,
Keele Street, North York, Ontario, Vancouver, British Columbia, Canada
Summary-Recent research has confirmed the presence of individual differences in dispositional levels of affect intensity as assessed by the Affect Intensity Measure (AIM). At present, research with the AIM has focused exclusively on subclinical samples. In the present study, we conducted an initial examination of the clinical relevance of affect intensity by assessing the criterion validity of the AIM in a psychiatric sample. A total of 61 psychiatric patients (3 I men, 30 women) were administered the AIM and the Millon Clinical Multiaxial Inventory. Evidence of the AIM’s criterion validity was obtained in that affect intensity was correlated positively with indices of borderline personality and passive-aggressive personality, and it was correlated negatively with compulsive+zonforming personality. In addition, affect intensity was associated signiticantly with numerous symptom measures of poor adjustment including somatoform symptoms, hypomania, alcohol abuse, and psychotic thinking. The results are discussed in terms of the clinical usefulness of assessing affect intensity in dysfunctional personality styles and other forms of psychopathology.
A recent development in the emotion literature is the recognition that there are consistent individual differences in levels of response intensity, and these individual differences predict a variety of phenomena. Larsen and Diener (1987) developed the Affect Intensity Measure (AIM) in order to measure the response intensity with which individuals typically experience positive and negative emotions. Respondents to the AIM are asked to indicate the extent of their agreement with statements such as “My happy moods are so strong that I feel like I’m in heaven” and “When I do something wrong I have strong feelings of shame and guilt.” Existing evidence suggests that the affect intensity construct has many potential research applications. For instance, dispositional levels of affect intensity, as assessed by the AIM, reliably predict cognitive appraisals of emotions (Dritschel & Teasdale, 199 1; Flett, Boase, McAndrews, Phner & Blankstein, 1986a; Larsen, Diener & Cropanzano, 1987) subjective reactions to life stress (Larsen, Diener & Emmons, 1986), styles of emotional expression (Flett, Bator & Blankstein, 1988), interpersonal reactions (Blankstein, Flett, Koledin & Bortolotto. 1989; Larsen & Diener, 1987) physiological reactions (Larsen & Diener, 1987) and perceptions of physiological reactions (Blascovich, Brennen, Tomaka, Kelsey, Hughes, Coad & Adlin, 1992). On the basis of this evidence, it has been concluded that affect intensity, as measured by the AIM, is an important aspect of temperament in adults (see Strelau, 1991). Since the AIM is a relatively new measure, many important issues involving the scale remain to be tested. Unfortunately, almost all of existing research with this instrument thus far has limited its focus to the study of the correlates of the AIM in subclinical samples of college students. The purpose of the present study was to assess the association between the AIM and indices of psychopathology in a clinical sample. Consistent with the general emphasis on the importance of affect in psychotherapy (Greenberg, Elliott & Foerster, 1990; Greenberg & Safran, 1987), a survey of the available literature on personal adjustment suggests that affect intensity may be particularly important in the experience of various forms of maladjustment. For instance, extant descriptions of personality disorders (e.g. American Psychiatric Association, 1987; Millon, 198 1) include descriptions of certain individuals who experience their affect with great intensity. Passive-aggressive personalities, for instance, have been described in the following manner: “Many are excitable and impulsive. Others suddenly burst into tears and guilt at the slightest upset. Still others often discharge anger or abuse at the least of *Address reprint requests to: Gordon L. Flett. Department Ontario, Canada
of Psychology.
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York University,
4700 Keele Street, North York.
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Gordon L. Flett and Paul L. Hewitt
provocations. The impulsive, unpredictable, and often explosive reactions of these personalities make it difficult for others to feel comfortable in their presence...” (Millon, 1981, p. 254). Similarly, the borderline personality has been described as experiencing intense affect. According to published reports, this affect is experienced often in the form of extreme anger directed toward others (Davis & Akiskal, 1986; Gunderson, 1984; Perry & Klerman, 1980; Snyder & Pitt, 1985) along with a great deal of conflict associated with the expression of this intense anger (Perry & Cooper, 1986). However, consistent with the definition of the affect intensity construct, borderline individuals have also been described as being characterized by intense feelings of such positive emotions as euphoria and excitement (Millon, 1981). Whereas the above personality disorders are believed to include intense affect, other personality disorders are believed to be characterized by extremely mild affect. The schizotypal personality, for instance, has been referred to as almost lacking affect entirely, even in situations that require an emotional response of some intensity (American Psychiatric Association, 1987). Likewise, the compulsive personality has been described as having restrained affectivity and little emotional expression (American Psychiatric Association, 1987; Goldstein, 1985; Pollak, 1987). In addition to the possible link between affect intensity and indices of Axis II personality disorders, it is likely that affect intensity is associated with other forms of maladjustment involving Axis I disorders such as depression and anxiety. Larsen and Diener (1987) have reported evidence indicating that greater affect intensity is associated with a measure of risk for bipolar illness in college students. They have also found that affect intensity is associated with indices of somatic and neurotic symptoms. Likewise, Williams (1989) and Dritschel and Teasdale (1991) reported a significant positive relation between affect intensity and neuroticism, while Dance, Kuiper and Martin (1990) reported a positive association between affect intensity and dysfunctional attitudes. Although these findings suggest that affect intensity is associated widely with a variety of adjustment problems, it should be reiterated that these data were obtained from nonclinical samples. Thus, the link between affect intensity and indices of psychopathology remains to be explored in psychiatric patients. Consequently, the main purpose of the present study was to examine the criterion validity of the AIM by testing the general hypothesis that individual differences in affect intensity are associated with measures of psychopathology in clinical patients. A sample of unselected psychiatric patients completed the AIM and the Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983) a well-known psychodiagnostic measure of personality dysfunction. The MCMI provides indices of various personality disorders as well as symptom measures of a variety of other adjustment difficulties involving Axis- I diagnoses, including hypomania, alcohol abuse, and psychotic reactions. Consequently, the use of the MCMI in the present study enabled us to determine the extent to which affect intensity is associated broadly with indices of psychopathology in a clinical sample. In addition, a secondary goal of this research was to examine the psychometric properties of the AIM in a clinical sample. Psychometric data are also reported below.
METHOD Subjects
The participants were 61 psychiatric patients (31 men, 30 women) from Brockville Psychiatric Hospital. The sample consisted of 27 inpatients and 34 outpatients with a variety of DSM-III-R diagnoses as determined by their respective clinicians. For instance, approximately 37% of the Ss were diagnosed as schnizophrenic, while 21% had a primary diagnosis of major depressive disorder, and 11% had some type of personality disorder. The remaining patients had a widespread variety of diagnoses including adjustment reaction, alcohol-drug dependence, and anxiety disorder, although patients with organicity were not included. The mean age of the Ss was 35.19 yr (SD = 10.36) with the ages ranging from 16 yr to 58 yr. All Ss had at least a grade eight education. The Ss were tested individually and paid 10 dollars for their participation. Materials and procedures Ss completed the AIM and the MCMI in a counterbalanced order. The AIM is a 40-item scale designed to measure the intensity with which individuals typically experience positive and negative
Validity of the Affect Intensity Measure
587
emotions. Respondents are asked to make six-point ratings of the extent of their agreement with such statements as “When I do something wrong I have strong feelings of shame and guilt” and “When I accomplish something difficult I feel delighted or elated.” The AIM consists of reactions to both positive and negative emotions and several items are reverse-keyed. A growing number of studies have attested to both the reliability and validity of the affect intensity construct as assessed by this instrument (Flett Blankstein, Bator & Pliner, 1989; Flett, Boase, McAndrews; Blankstein & Pliner, 1986b; Goldsmith & Walters, 1989; Larsen & Diener, 1985, 1987). The MCMI is a 175-item true-false instrument that contains 20 scales relevant to DSM-III (American Psychiatric Association, 1980). It provides subscale scores of relatively mild personality disorders (i.e. schizoid-asocial, avoidant, dependent-submissive, histrionic-gregarious, narcissistic, antisocial-aggressive, compulsive-conforming and passive-aggressive) as well as more severe personality disorders (i.e. schizotypal, borderline and paranoid). It also provides a number of other symptom-related subscales (i.e. anxiety, somatoform, hypomania, dysthymia, alcohol abuse, drug abuse potential, psychotic thinking, psychotic depression and psychotic delusion). There is evidence of the MCMI’s concurrent validity (Gibertini, Brandenburg & Retzlaff, 1986; McMahon & Davidson, 1986; Millon, 1983), face validity (Moreland & Onstad, 1987), and stability (Choca, Peterson & Shanley, 1986; McMahon, Flynn & Davidson, 1985; Piersma, 1986) in a variety of populations. Thus, it was deemed suitable for the purposes of the present study.*
RESULTS
The mean AIM score for the sample as a whole was 152.21 (SD = 22.65) with an internal consistency alpha of 0.84. AIM score did not differ significantly as a function of inpatient-outpatient status. An analysis of variance did yield a significant gender difference, F (1, 59) = 4.84, P < 0.05. Consistent with other research, women reported higher AIM scores. The respective means for women and men were 158.50 (SD = 23.24) and 146.13 (SD = 20.65). Pearson product-moment correlations were computed between the AIM and the MCMI measures for the sample as a whole. The results are displayed in Table 1. Significant correlations were obtained between the AIM and the MCMI personality disorder measures of compulsive-conforming personality, r = - 0.35, P -=c 0.01, passive-aggressive personality, r = 0.3 1, P < 0.05, and borderline personality, r = 0.3 1, P < 0.05. That is, while extremely low affect intensity was associated with a compulsive-conforming personality, high affect intensity was associated with passive-aggressive and borderline tendencies. Affect intensity was not correlated significantly with other personality disorder measures in the total sample. In addition, the AIM was correlated significantly with MCMI symptom indices of hypomania, r = 0.29, P < 0.05, somatoform symptoms, r = 0.29, P < 0.05, alcohol abuse, r = 0.28, P < 0.05, psychotic thinking, r = 0.28, P < 0.05, and psychotic delusion, r = 0.25, P < 0.05. Marginally significant correlations were obtained between the AIM and measures of drug abuse potential, r = 0.23, P < 0.10, and psychotic depression, r = 0.23, P < 0.10. Correlations were computed separately for males and females. These results are also shown in Table 1. It can be seen that most of the correlations between the AIM and the MCMI personality disorder measures were not significantly different between males and females. For instance, the correlations were - 0.32 and - 0.30 between the AIM and the MCMI compulsive-conforming subscale for males and females, respectively. However, some gender differences did emerge. Affect intensity was correlated significantly with paranoid personality disorder in males, r= 0.58, PCO.05,but these measures were not correlated significantly in females, r = - 0.04, ns. Similarly, the AIM was correlated with psychotic thinking, r = 0.40, P < 0.IO,and psychotic delusion, r = 0.53, P < 0.01, in males. However, the same variables were not correlated significantly in females. These findings suggest the importance of examining separately the results for males and females in future research of this nature. *Most importantly, a closer examination of the MCMI item content revealed no items that directly involved affect intensity judgements. Consequently, it is unlikely that the subsequent results merely reflected overlap in the content of the MCMI and the AIM.
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L. Flett and Paul L. Hewitt
Table I. Correlations between the AIM and MCMI MCMI
measure
Total
Pmonnli~ disorder men~ures Schizoid-asocial Avoidant Dependent-submissive Histrionic-gregarious Narcissistic Antisocial-aggressive Comou I sive*onforminz Pas&e-aggressive Schizotypal Borderline-Cycloid Paranoid slwlprorncrtcdo~~ n,e‘,su)Y Anxiety Somatoform Hypomania Dysthymia Alcohol abuse Drug abuse potential Psychotic thinking Psychotic depression Psychotic delusion Note. ***P
**p
measures
Males
Females
0.08 0.20 0.17 - 0.1 1 - 0.03 0.1 I - 0.35*** 0.31** 0.04 0.31** 0.15
- 0.01 0.17 0.30 0.18 0.23 0.27 - 0.32* 0.18 0.26 0.27 0.58**
-0.01 0.08 0.02 -0.14 - 0.07 0.1 I - 0.30 0.30 - 0.19 0.18 - 0.04
0.13 0.29** 0.29** 0.17 0.28** 0.23* 0.28*’ 0.23* 0.25**
- 0.08 0.28 0.44* 0.00 0.24 0.45* 0.40* 0.24 0.53**
0. I3 0.14 O.IY 0.15 0.30* 0.23 0.02 0.02 0.02
*P
DISCUSSION The purpose of the present study was to examine the criterion validity of the AIM by investigating the link between stable individual differences in affect intensity and a self-report measure of psychopathology in a clinical sample. Overall, the analyses provided initial evidence of the criterion validity of the AIM in psychiatric patients. Our results indicated that a dispositional tendency to experience intense affect was associated significantly with the presence of a personality style typified by passive-aggressive and borderline characteristics. In contrast, a dispositional tendency to experience extremely low levels of affect intensity was correlated significantly with a compulsiveconforming personality. Thus, these data are generally consistent with reports suggesting that individuals with personality disorders such as borderline personality disorder are high in affect intensity while individuals with personality disorders such as compulsive personality disorder suffer from constricted affect. Overall, these data suggest that individual differences in affect intensity may contribute to various forms of psychopathology and the AIM may be a useful measure when assessing personality dysfunction. Although the data indicated a general association with personality disorder indices, affect intensity was not correlated significantly with other personality disorder subscales in the dramatic cluster which, on the surface, seemingly involve a high level of emotional response intensity. Individuals with the histrionic personality, for example, are described as manifesting short-lived, dramatic displays of affect (American Psychiatric Association, 1987). Why then was affect intensity not correlated significantly with the corresponding MCMI histrionic personality subscale? One possibility is that certain disorders within the dramatic cluster are characterized by emotional lability rather than affect intensity per se. That is, these disorders may be characterized more by variable emotional states that may or may not be experienced at an extreme level of intensity. It has been suggested elsewhere that affect intensity and affect lability may indeed be somewhat independent (Harvey, Greenberg & Set-per, 1989). Thus, future research in this area should examine both affect intensity and affect lability in order to obtain a more complete understanding of the role in psychopathology of trait-related differences in affectivity. A related goal of the present study was to further examine the criterion validity issue by investigating the link between affect intensity and specific psychological symptoms that reflect Axis I disorders. The findings involving the MCMI symptom subscales extended past research by showing that affect intensity was associated with a variety of severe psychological symptoms including hypomania, sonatoform disorder, psychotic thinking, and alcohol abuse in this clinical sample of psychiatric patients. The link between affect intensity and hypomania is consistent with past indications of an
Validity of the Affect Intensity Measure
589
association between affect intensity and symptoms of bipolar depression in college students (Larsen & Diener, 1987). Similarly, the association between affect intensity and somatoform symptoms is consistent with past research with college students (Larsen & Diener, 1987) and may reflect an association between affect intensity and a tendency to experience psychosomatic symptoms. The link between affect intensity and health outcomes is an important avenue for further research. Finally, the obtained link in the present study between affect intensity and alcohol abuse was not unexpected, in that affect intensity is associated with higher self-consciousness (Flett et al., 1986) and a great deal of research has demonstrated the role of chronic self-focused attention in alcoholism (Hull & Young, 1983; Hull, Young & Jouriles, 1986). Clearly, each one of the current findings needs to be replicated. However, on the basis of the current results, it does seem reasonable to conclude that the affect intensity construct is a relevant variable to study in clinical samples and it may be involved in various forms of psychopathology. Clearly, the present findings have several practical and theoretical implications. For instance, at the practical level, the results involving the personality disorder measures suggest that a consideration of affect intensity may be particularly useful in the classification and differential diagnosis of personality disorders. The fact that affect intensity was not correlated significantly with every measure of personality disorder in the present study suggests that a determination of levels of this personality trait may enable clinicians to make important discriminations among the various personality disorders. At the theoretical level, the current findings underscore the need for comprehensive models of psychopathology that incorporate individual differences in affect intensity. A growing literature on affect intensity has provided numerous findings that must be incorporated into future models. For instance in a recent study, Fujita Diener and Sandvik (1991) examined gender differences in affect intensity and well-being in college students. Fujita et ul. (1991) analyzed multiple measures of affect intensity and hedonic level. They concluded that women and men are equally happy despite the fact that women experience more intense negative affect, in part because women’s intense positive emotions tend to balance their intense negative emotions. This suggests that people with high affect intensity are not necessarily prone to poor personal adjustment because intense negative emotions may be offset by intense positive emotions and experiences. However, the current findings with psychiatric patients suggest that affect intensity is associated with symptoms of psychopathology for certain individuals who may be less likely to experience positive events. Theoretical explanations must identify the variables that combine with affect intensity to produce maladjustment. Perhaps affect intensity operates as a diathesis factor that must be experienced in conjunction with other factors such as low social support. Similar sequences have been proposed for other personality variables involved in psychopathology (see Hewitt & Flett, 1991). Clearly. there is need for theoretical models of adjustment that examine affect intensity within the context of other variables or processes. Regarding these future models, one focus of likely importance is the association between affect intensity and cognitive processing. Existing research indicates the individuals with high levels of affect intensity may have more vivid and intense autobiographical memories (Flett et al., 1986a; Fujita rt ul., 199 I ). Also, research suggests that high AIM scorers engage in the cognitive operations that are believed to contribute to bouts of depression (see Dritschel & Teasdale, 199 I ; Larsen et al., 1987). These findings with cognitive variables may provide the basis for elaborate models of affect intensity and personal maladjustment that focus on information processing. Although the present study has demonstrated the potential usefulness of the affect intensity variable among individuals characterized by severe dysfunction, it is evident that many questions remain to be answered. Future research must address several issues related to psychopathology. For instance, Larsen and Diener (1987) stated that individuals have dispositional levels of intense affect irrespective of the valence of affect. The results of several studies support this claim (e.g., Diener rt al., 1985; Flett ef Cal., 1986a). On the other hand, it is well-known clinically that individuals with severe levels of depression, for example, experience negative or aversive affect states very intensely, whereas more positive affect states are often not experienced at all. Some authors have suggested that the absence of positive affect is the defining feature of depression that distinguishes it from anxiety (Clark & Watson, 199 1). In light of this observation, it would be interesting to examine individual differences in affect intensity for positive vs negative affect states in clinically depressed Ss. One might expect that the intensity of experienced affect would differ greatly depending on whether a positive or a negative affect state is present in these Ss.
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The limitations of the current study should be acknowledged. First, it must be reiterated that our findings were based on an unselected psychiatric sample. It is important that future research examines levels of affect intensity and related psychometric properties of the AIM in groups of Ss with specific diagnoses because the use of a heterogenous sample may have obscured some important relations in the present study. Initial data relevant to this issue are promising and indicate a link between affect intensity and certain diagnoses, including personality disorders. For instance, in a recent unpublished study, we compared Ss with a diagnosis of either borderline personality disorder, major depressive disorder, adjustment disorder, or schizophrenia. There were 13 patients in each group. We found that significantly higher AIM scores were reported by the patients with either a major depressive disorder (M = 169.85, SD = 22.53) or a borderline personality disorder (M = 165.38, SD = 22.59), vs those patients with a diagnosis of either an adjustment disorder (M = 152.59, SD = 9.94) or schizophrenia (M = 150.08, SD = 21.65). The finding that elevated levels of affect intensity were present among those patients with a diagnosis of borderline personality disorder is consistent with the results of the current study. The other main limitation of the current study involves its cross-sectional nature. The methodology of the current study permits a test of the criterion validity of the AIM, but it does not enable us to make any statements about the possible role of affect intensity in vulnerability to certain personality disorders. It is important that future research examines affect intensity and psychopathology in a prospective design. It is particularly important to determine whether AIM scores remain elevated among those Ss whose symptoms abate. These limitations notwithstanding, the results of the present study provided initial support for the criterion validity of the AIM when administered to psychiatric patients. The results confirmed that affect intensity, as assessed by the AIM, is associated significantly with certain personality disorder indices and it is correlated with several MCMI clinical symptom scales. Overall, these data indicate the need to examine affect intensity in severe forms of maladjustment. It is our hope that the current research will serve as further impetus for research and theory on the role of affect intensity in severe forms of psychopathology.
AcknoMle~l~smlrrl~.s-This research was conducted while the second author was at Brockville Psychiatric Hospital. This research was supported in part by a grant awarded to the authors by the Research and Program Evaluation Committee, Brockville Psychiatric Hospital, as well as a Social Sciences and Humanities Research Council of Canada Research Fellowship awarded to the first author. The authors wish to thank Wendy Tumbull and Marjorie Cousins for their help in gathering the data. Requests for reprints should be addressed to Gordon Flett, York University, Dept. of Psychology, 4700 Keele Street, North York, Ontario, M3J I P3, Canada.
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of the Affect
Intensity
Measure
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