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Psychological Assessment1992, Vol. 4, No . 1,5-13In the public domain

Normal Personality Assessmentin Clinical Practice:The NEO Personality InventoryPaul T. Costa, Jr.,and Robert R. McCraeGerontology Research CenterNational Institute on Aging, National Institutes of HealthBaltimore, Maryland

Personality psychologists from a variety of theoretical perspectives have recently concluded thatpersonality traits can be summarized in terms o f a 5-factor m odel. This article describes the NEOPersonality Inventory (NEO-PI), a m easure of these 5 factors and some of the traits that definethem, and its use in clinical practice. Recent studies suggest that NEO-PI scales are reliable andvalid in clinical samples as in normal samples. The use of self-report personality measures inclinical samples is discussed, and data from 117 "normal" adult men and women are presented toshow links between the NEO-PIscalesand psychopathology as m easured by Jackson's (1989) BasicPersonality Inventory and Morey's (1991) Personality Assessment Inventory. W e argue that theNEO-PI m ay be useful to clinicians in understanding the patient, formulating a diagnosis, estab-lishing rapport, developing insight, anticipating the course of therapy, and selecting theoptimalform o f treatment for the patient.

In the past two decades there has been remarkable progressin one of the oldest branches of personality psychology: thestudy of traits or individual differences. The conceptual statusof traits has been clarified (Costa & McCrae, 1980; Funder,1991; Tellegen, in press), and trait measures have shown evi-dence of convergent and discriminant validity across instru-ments (McCrae, 1989) and observers (Kenrick & Funder, 1988).Longitudinal studies of both self-reports and ratings haveshown impressive stability of a wide range of traits across theadult lifespan (Block, 1981; McCrae & Costa, 1990). Perhapsmost exciting is the growing agreement among personality psy-chologists that most individual differences in personality canbe understood in terms of five basic dimensions: Neuroticism(N) vs. Emotional Stability; Extraversion (E) or Surgency;Openness to Experience (O) or Intellect; Agreeableness (A) vs.Antagonism; and Conscientiousness (C) or Will to Achieve(Digman, 1990; John, 1990; Norman, 1963; Wiggins & Trap-nell, in press). These factors have been recovered in studies ofself-reports and ratings, lay adjectives and standardized ques-tionnaires, adults and children, and several different cultures.

This five-factor model is a theoretical advance that has im-portant implications for many applied areas, including clinicalpractice. By assessing traits f rom each of the five factors, theclinician can obtain a comprehensive portrait of the client'spersonality,and the clinical researcher can systematically exam-ine relations between personality and treatment variables. Re-cent articles and symposia have examined the utility of thefive-factor model in counseling (McCrae & Costa, 1991), ab-normal psychology (Widiger & Trull, in press), and clinicalpsychology (Spielberger, 1989). This article is intended to de-

Correspondence concerning this articleshould be addressed to PaulT. Costa, Jr., Laboratory of Personality and Cognition, GerontologyResearch Center, 4940 Eastern Avenue, Baltimore, Maryland 21224.

scribe a measure of the five factors, the NEO Personality Inven-tory (NEO-PI; Costa & McCrae, 1985, 1989), and its use inclinical settings.

Of course, "normal" personality assessment, using such in-struments as the Sixteen Personality Factor Questionnaire(16PF; Cattell, Eber, &Tatsuoka, 1970) and the California Psy-chological Inventory (CPI; Gough, 1957), has long been part ofclinical practice. The NEO-PI is, however, the first inventorybased on the five-factor model, and a discussion of its use mayprovide some fresh perspectives on the relevance of normalpersonality traits to clinical psychology.

Cliniciansoften think of psychological assessment as part ofthe diagnostic process. Although not designed as a measure ofpsychopathology, we believe the NEO-PI can contribute infor-mation that is relevant to diagnosis. But perhaps more impor-tant are the ways in which the instrument may help the clini-cian understand the patient, select appropriate treatments, andanticipate the course and outcome of therapy. For these pur-poses, much more is needed than measures of psychopathol-ogy; the full range of personality characteristics must be consid-ered, and it is here that the five-factor model provides a guide.

The first factor, Neuroticism, ismost familiar to clinicians. Itrepresents the individual's tendency to experience psychologi-cal distress, and high standing on N is a feature of most psychi-atric conditions. Indeed, differential diagnosis often amountsto a determination of which aspect of N (e.g., anxiety or depres-sion) is most prominent. Wewill discuss later the relations be-tween this dimension of personality and psychopathology.

Extraversion is the dimension underlying a broad group oftraits, including sociability,activity, and the tendency to experi-ence positive emotions such as joy and pleasure. Patients withhistrionic and schizoid personality disorders differ primarilyalong this dimension (Wiggins & Pincus, 1989), and Miller(1991) has pointed out that talkative extraverts respond very


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PAUL T. COSTA, JR., AND ROBERT R. McCRAEdifferently to talk-oriented psychotherapies than do reservedand reticent introverts.

Clinical psychologists may recognizeOpenness to Experienceasone of the goalsofRogerian therapy. We use the term to referto abroader constellation oftraits. High-Oindividuals areimag-inative and sensitive to art and beauty and have a rich andcomplex emotional life; they are intellectually curious, behav-iorally flexible, and nondogmatic in their attitudes and values(McCrae & Costa, 1985, in press). Although these traits areprobably considered desirable by most clinicians, they are notnecessarily associated with good mental health: Conventional-ity and conformity are also viable paths to adjustment. Differ-ences in O are related, however, to the manifestations of psycho-pathology (e.g., high-O individuals tend to use intellectualiza-tion as a defense, whereaslow-O individualsuse suppression ordenial, McCrae & Costa, in press) and to the types of treatmentthat the patient is likely to find acceptable.

Agreeableness, like E, is primarily a dimension of interper-sonal behavior. High-A individuals are trusting, sympathetic,and cooperative; low-A individuals are cynical, callous, and an-tagonistic. As Homey (1945) pointed out in her distinction be-tween moving toward and moving against others, both ends ofthis factor may be associated with psychopathology. In addi-tion, A is clinically important because it directly affects therapport between patient and therapist (Muten, 1991).

Finally, Conscientiousness is a dimension that contrasts scru-pulous, well-organized, and diligent people with lax, disorgan-ized, and lackadaisical individuals. The former aremore proneto compulsive personality disorder, the latter to antisocial per-sonality disorder (Lyons, Merla, Ozer, & Hyler, 1990). Con-scientiousness is associated with academic and vocational suc-cess (Digman & Takemoto-Chock, 1981); to the extent thatpsychotherapy can be considered work, C should also affect theoutcome of therapy, and there is some evidence that it does(Miller, 1991).

In a brief introduction such as this, it is natural to focus onthefivebroad domains rather than on the individual traits thatconstitute them, and those who are unfamiliar with the five-factor model are well advised to attend first to the distinctionsamong the domains. In the long run, however, the detailedinformation that clinicians need can only be provided by aninstrument that makes distinctions within the domains. Forexample, anxiety and depression are both aspects of N, but thedistinction between them is often critical in selecting appro-priate treatment. The NEO-PI is intended to offer both aglobal portrait of the individual's personality and more detailedinformation on specific facets of the broad domains.

Assessing Personality: The NEO-PIThe NEO-PI wasdeveloped over the past 15 years asa mea-

sure of the five-factor model. Our original interest was in onlythreeof the factors that weconceptualized asbroad domainsN, E, and Oeach containing many more specific traits orfacets (Costa & McCrae, 1980, in press-c). The NEO Inventory(as it was then called) included six8-item facet scales for each ofthe three domains. Research on the five-factor model per-

suaded us to include two newer, 18-item scales to measure Aand C when the NEO-PI was published in 1985. Facet scales forA and C are being developed and should be available soon(Costa & McCrae, in press-c; Costa, McCrae, & Dye, 1991) .

The current 181-item version of the inventory has two fo rms:S for self-reports, and R for observer ratings, with parallel itemsphrased in first- and third-person. Items are answered along a5-point Likert scale from strongly disagree to strongly agree,and scales are balanced to control for the effects of acquies-cence. Table 1 lists the domain and facet scales of the NEO-PIand some of their psychometric properties.

Despite the brevity of the facet scales, most have good inter-nal consistency, and all show substantial stability (which is alower-bound estimate of reliability) over a 6-year interval. Per-haps the most important data in Table 1 are given in the lastcolumn: These arevaliditycoefficients that demonstrate signif-icant and substantial agreement across sources for all 18 facetsand five domain scales. Additional validity studies haveexam-ined correlations with peer ratings, a wide variety of other ques-tionnaires and adjective checklists, sentence completions, andexpert ratings based on spontaneous self-concept descriptions(Costa & McCrae, 1985, 1989). Recent reviews of the instru-ment are providedby Hogan (1989) and Leong and Dollinger(1990).

Although layobserver rating scales have been widely used inpersonality research, they have rarely been published. Form Rof the NEO-PI is available in two versions (one for rating menand the other for rating women) and has profile sheets based onnormative studies of adults. As Table 1 shows, the scales ofForm R show a pattern of reliability and stability very similarto that seen for Form S, and the self-spouse correlations in thefifth column are also evidence of the validity of Form R scales.Similar results (with rs ranging f rom .32 to .54, p < .001) arefound for individual peer ratings, and larger correlations areseen when ratings are aggregated across peers (McCrae &Costa, 1989). Webelieve that ratings by knowledgeable otherscan and should be more widely used as an adjunct to the self-re-ports usually found in clinical assessment (cf. Muten, 1991).

Other features designed to make the NEO-PI more useful toclinicians include computer administration, scoring, and inter-pretation; a mail-in scoring system; separate norms for collegestudents; a short, 60-item version (the NEO Five Factor Inven-tory, or NEO-FFI) that gives scores for the five domains onlyand may be useful when time for assessment is limited; and atest feedback sheet (Your NEO Summary) that can be used toinvolve the patient therapeuticalry in what McReynolds (1989)called "client-centered assessment."Until recently, almost all research on the NEO-PI was con-ducted on normal volunteer samples, and clinicians may right-fully wonder how well its psychometric properties hold up inclinical populations when used as part of clinical assessment.The nature of the sample or the conditions of administrationcould affect thevalidityof the instrument. Three recent studieshave examined the instrument in three different clinical set-tings: a behavioral medicine clinic (Muten, 1991), a sexual be-haviorsconsultationunit (Pagan etal,1991), and aprivate clini-cal practice (Miller, 1991). In all three samples, patients scoredabout one standard deviation higher in N and about one-half


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SPECIAL SECTION: NEO-PI IN CLINICAL PSYCHOLOGYTable1Some Psychometric Properties of NEO-PI Scales fo r Self-Reports(Form S) and Spouse Ratings (Form R )

Coefficient alpha

NEO-PI scaleNeuroticismAnxietyHostilityDepressionSelf-consciousnessImpulsivenessVulnerabilityExtraversion

WarmthGregariousnessAssertivenessActivityExcitement SeekingPositive EmotionsOpennessFantasyAestheticsFeelingsActionsIdeasValuesAgreeablenessConscientiousness

FormS(n = 983)

.93.85.77.84.74.73.77.87.75.66.76.74.67.79.89.81.81.75.64.79.74.76.86

Form R(n = 167)

.94.89.87.87.74.79.82.88.84.79.72.82.66.81.91.84.86.79.73.84.76.88.91

6-year stabilityFormS

(n = 398).83.75.7 4.70.79.70.7 3.82.72.73.79.75.73.73.83.73.79.68.70.79.71

Form R(n = 167)

.83.75.78.7 2.76.75.68.77.75.73.72.68.69.77.80.73.79.70.75.75.76

Self-spouseagreement(=135)

.54.51.60.47.38.53.32.53.51.54.53.48.45.53.60.40.62.43.47.53.63.50.43Note. Adapted from Costa& McCrae, 1988. In the public domain. Allcorrelationssignificantatp < 001.Agreeableness and Conscientiousness were not measured at baseline.

standard deviation lower in A and C than did normal volun-teers; they did not differ in E or O.Further, standard deviationsthemselves were comparable to normative values, suggestingthat the metric providedby the norms isappropriate fo r clini-cal samples. Pagan et al. reported reliabilities for the domainsof .94, .87, .90,'.76, and .85 fo r N, E, O, A, and C, respectively(values that are virtually identical to those found in the firstcolumn of Table 1) and replicated the factor structure of thefacet scales. Muten showed that Form S NEO-PI scales weremeaningfully related toother self-report scales in hisbehavioralmedicine sample, and significantly correlated with spouse rat-ings on FormR, withcross-observer correlations ranging from.29 to .71. Piven et al. (1990) reported significant correlationsbetween NEO-PI domain scales and expert ratings of four ofthe factors based on psychiatric interviews. Suchfindings sug-gest that clinician ratings of personality are likely to concurwith patient self-reports.These studies are certainly encouraging, but they representonly the first stages of research on the use of the NEO-PI inclinical samples.Many questions needtobeaddressed in futurestudies: For what other clinical populations (inpatients, psy-chotics, adolescents) is the NEO-PI appropriate? How doestreatment affect NEO-PI scores? Whatare the personality pro-files of different diagnostic groups? How do personality traitsof the clinician interact with thoseof the patient? Howwell doself-reports or lay ratings agree with clinician's views of thepatient's personality? Does the NEO-PI offer incremental va-lidityover traditional measuresof psychopathology in predict-

ing diagnosisor prognosis? Researchon all these topics wouldbewelcome.

Special Concerns in Clinical AssessmentThe traditional distinction between normal and abnormalpsychology has led some clinicians to the belief that instru-

ments designed for the measurement of normal personality di-mensions are irrelevant to or inappropriate for clinical assess-ment. W e believe this conclusionis unjustified, for tw o reasons.First, the populations overlap considerably: An appreciablenumber of individuals in normal volunteer samples wouldbefound to have diagnosable psychiatric disorders if they weresystematically assessed, and many of the patients whom clini-cal psychologists treat are relatively well-adjusted individualsfacing situational stressors. Second, many aspects of personal-ity are relatively unaffected by psychopathology. The presenceof an anxiety disorder, fo r example, need no t affect one's intel-lectual curiosity or need for achievement. Although there arecertainly circumstances (such as advanced dementia or cata-tonia) inwhich the assessment of normal personalityis impossi-ble and perhaps meaningless,webelieve that most patientscanbe profitably described in terms of the dimensionsof the five-factor model, and that the NEO-PI will be a useful way tomeasure standingonthese dimensions. However, thereare twoissues that require special consideration here:(a)problems oftest invaliditydue to defensiveness, socially desirable respond-


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8 PAUL T. COSTA, JR., AND ROBERT R. McCRAEing, or malingering,and (b) effects ofpsychopathology itself onpersonality scale scores.

Defensiveness, Social Desirability, an d MalingeringNEO-PI items are obvious; that is, they ask directly about

the characteristics they are intended to measure. There arethree major ways in which the resulting personality scale scorescan be interpreted. The most straightforward is to view them asmeasuresfallible measures, and thus actually estimatesofwhat the individual is really like. A more subtle, second inter-pretation is that they represent the individual's self-concept:how he or she sees him- or herself. Third, questionnaire re-sponses, and thus scale scores, can be seen as self-presentation.In this view, scores represent the ways in which the individualwishes to be viewed by others, either in general or on the spe-cific occasion when the test is administered. It is probably thecase that allthree interpretations arecorrect tosome extent; theinterpreter's task is to determine howmuch weight to assign toeach.

It is in regard to this issue that the NEO-PI breaks mostclearly with the traditions of testing in clinical psychology. Per-haps because of the early influence of psychoanalysis (with itsemphasis on unconscious processes and mechanisms of de-fense), concerns about defensiveness, social desirability, faking,and malingering have created in the minds ofmanyclinicians aprofound mistrust of patient self-reports. In response, psycho-metricians have expended prodigious efforts seeking ways toavoid, detect, or correct for these sources of invalidity. TheMMPI used empirically keyed scales with subtle items, andmost clinical instruments (suchasJackson's, 1989, Basic Person-ality Inventoryand Morey's, 1991, Personality Assessment In-ventory) include validityscalesto measure lying, defensiveness,or socially desirable responding. Although NEO-PI inter-preters are of course advised to check protocols for missing dataand evidence of gross acquiescence or random responding(Costa & McCrae, 1989), special validity scales are not in-cluded. A single item that baldly asks respondents whether theyhave answered the questions honestly and accurately is the onlyvalidity check.

The omission of validity scales was not an oversight, but adecision based on several lines ofevidence and reasoning thatneed to be understood by users of the NEO-PI. Wewould notdeny that personality scores are sometimes distorted by re-sponse sets and styles, and that individuals, particularly thosewith emotional and interpersonal problems, frequently lack in-sight into their own personalities. But we believe that theseproblems are not as crippling as they are of ten portrayed, andthat there are better ways to deal with them than through theuse of validity scales.

There is substantial evidence that self-reports from patientsare, in general, trustworthy. For example, Jackson (1989)showed convergent correlations between Basic Personality In-ventory (BPI) scales and professional ratings of hospitalizedpsychiatric patients, ranging from .31 to .51 (all p < .05);corrected for unreliability of the ratings, these correlations roseas high as .66. Muten's (1991) data show similar levels of agree-ment between patients' self-reports and their spouses' ratingson the NEO-PI.

There is also evidence that attempts to improve the validityof self-reports through the use of special items or scales is oftencounterproductive. Wrobel and Lachar (1982) showed thatscales using subtle items were less valid than those composedofobvious items. Aseries of studies using normal volunteer sam-ples hasshown that correcting self-reports using lie, social desir-ability, and defensiveness scales does not increase their validitywith respect to external criteriaindeed, in many cases itsub-stantially reduces their validity (McCrae, 1986; McCrae &Costa, 1983; McCrae et al., 1989). These paradoxical findingsresult f rom the inability of most social desirability scales todistinguish between individuals who falsely present themselvesas having desirable characteristics and those who accuratelyreport desirable traits. Certainly for normal samples thedangers of mistakenly distrusting valid self-reports outweighthe benefits of identifying invalid responses, and we suspectthat the same will hold true in clinical samples.

Thesuccessof psychologicalassessment depends inconsider-able measure on the clinician's ability to elicit the patient'strust, interest, and cooperation. The use of instruments de-signed to outwit or entrap the respondent hardly contributes tothe development of rapport. We recommend that clinicianswho use the NEO-PI explain to their patients that it measuressome of the important ways in which people differ in theirthoughts, feelings, and actions, and that honest responses wil lcontribute to the success of clinical evaluation or therapy. Wethink these instructions wil l lead to valid scores in most cases.

There are doubtless occasions when self-reports are not trust-worthy. A patient may be uncooperative or cognitively im-paired, or mayhavepowerful incentives to distort self-presenta-tion. We think it is unlikely that useful information wil l beobtained f rom self-reportsinsuch cases, withorwithoutthe useof corrections, and this was one of the major reasons wedevel-oped and validated the observer rating f o r m of the NEO-PI.W e would encourage clinicians to use ratings f rom knowledge-able informants such as spouses or parents as an adjunct to orsubstitute for self-reports whenever there is reason to suspectthat self-reports may be seriously distorted.

Effects of Psychopathology on Scale ScoresResponses to personality questionnaire items are based on

the self-image, the view the individual has of him- or herself.Studies comparing self-reports with observer ratings supportthe conclusion that self-images are generally accurate (McCrae&Costa, 1989), but clinical psychology provides many counter-examples, f rom delusions of grandeur to distortions of body-image among anorectics. In some cases, such irrational beliefsabout the self may affect personality trait measures, and theclinician must keep this possibility in mind when interpretingscores.

One example is provided by narcissism. Narcissists have aninflated self-image, and may portray themselves as well-ad-justed, extraverted, and perhaps conscientious. But studies us-ing both normal (Costa & McCrae, 1990) and psychiatric(Lyons et al., 1990) samples have found negative correlationsbetween narcissism and self-reported Agreeableness, so appar-ently narcissists are not prone to describe themselves as hum-ble, sympathetic, or self-effacing. Nevertheless, personality rat-


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SPECIAL SECTION: NEO-PI IN CLINICAL PSYCHOLOGYings might be particularly useful in cases in whicha diagnosisof narcissism is suspected.

A more pervasive problem, and one on which there isalreadysome research, is the effect of mood disorders on self-presenta-tion. There is considerable evidence that temporary moods donot influence scores on personality inventories in normal sam-ples (Costa & McCrae, in press-b; Underwood, Framing, &Moore, 1980). But clinical depression does affect self-image:Depressed patientshave loweredself-esteem that is manifestedin their responses. Itappears that the primary effect ofthis biasis seen on measures related to Neuroticism. Liebowitz, Stal-lone, Dunner,and Fieve (1979) have reported that Neuroticismscores, but not Extraversion scores, increased as patients en-tered a depressive phase. Hirschfeld et al. (1983) administeredthe Maudsley Personality Inventory(MPI; Eysenck, 1962) andthe Guilford Zimmerman Temperament Survey (GZTS; Guil-ford, Zimmerman, & Guilford, 1976) twice to depressed menand women and reported that measures of N (MPI Neurotic-ism and GZTS Objectivity, reversed) decreased over a 1-yearperiod for depressed patients who had recovered, but not forthose who had not. Recovery from depression did not lead tochanges in GZTS General Activity and Ascendance (measuresof E) or GZTS Thoughtfulness (a measure of O).

Additional studies, especially including measures of A andC, are needed here, but it appears that the major effect of de-pression is to exaggerate scores on measures of N. Because indi-viduals who are prone to depression are also likely to have ele-vated premorbid N scores (Hirschfeld et al., 1989), this bias isunlikely to change the overall shape of the personality profile.Most important, depression isunlikely to affect scores on E andO,dimensions that may be useful in selecting the optimal formof therapy (Miller,1991).

Linking Clinical and Normal Personality InstrumentsW e have argued that most clinical populations are not dra-

matically different f rom normal volunteer samples with regardto the structure of personality. Similarly,wewould argue thatmost dimensions of psychopathology have parallels in dimen-sions of individual differences in the normal range. One of theintriguing questions for future research concerns the nature ofthe relation between traits and psychiatric disorders: Do traitspredispose individuals to certain disorders or result f rom thedisorders, or are mental disorders merely extremeforms ofoth-erwise normal personality characteristics (cf. Widiger &Trull,in press)? Whatever the form of the relationship, weknow frommany studies that there is substantial overlap between mea-sures of personality and psychopathology, and pointing outthese correspondences may be a useful way to acquaint theclinician with the constructs measured by the NEO-PI.

Previousstudies (Costa&McCrae, 1990; McCrae,1991) haveexamined correlations between the NEO-PI factors and scalesfrom two of the most widely used clinical instruments, theMinnesota Multiphasic Personality Inventory (MMPI; Hatha-way & McKinley, 1983)and the Millon Clinical Multiaxial In-ventory (MCMI; Millon, 1983); most of the scales were relatedto N or E. Wehave recently collected data on two newer mea-sures of psychopathology: Jackson's BPI and Morey's Personal-ity Assessment Inventory (PAI). Bothofthese instruments were

intended to provide psychometrically sophisticated measuresof major dimensions of psychopathology in both normal andclinical populations. Both instruments were administered to asubsample of men and women in the Baltimore LongitudinalStudy of Aging (BLSA; Shock et al., 1984) who had completedthe NEO-PI 2 years earlier. The 60 men and 57 women whoprovided data on one or both instruments ranged in age from21 to 94, with mean agesof 67.5 and 64.5, respectively.

Because both these instruments are relatively new, it is ofinterest to consider first their convergent and discriminant va-lidity as alternative measures of psychopathology. In general,good agreement was found. For example, PAI Somatic Com-plaint had its highest correlation (r = .72) with BPI Hypochon-driasis; PAI Anxiety and Anxiety-Related Disorder scales hadtheir highest correlations with BPI Anxiety (rs= .66, .48, respec-tively). Intercorrelations among all the scales in Tables 2 and 3are available from us.

Table 2 gives correlations between the NEO-PI domainscales and BPI scales. The correlations of Anxiety with N, So-cial Introversionwith E,Denial with O,Interpersonal Problemswith A, and Impulse Expression withC require little comment;they show the parallelism between psychopathological andnormal personality dimensions that we hypothesized. The neg-ativecorrelation between BPI Denial and N illustrates the prob-lematic nature of validity scales. Should we conclude that someindividuals score low on N because they deny undesirable traitsthey possess, orshouldweconclude that people lowon Nreallyhave fewer undesirable traits? Both are logically possible, andwe suspect the latter is more plausible. Data f rom observerratings would be needed to resolve this issue.

It is notable that only one of the BPI scales, Thinking Dis-order, is unrelated to any of the five factors. This finding isconsistent with earlier speculations that "a sixth dimension ofaberrant cognitions might be needed to fully describe personal-ity disorders"(Costa &McCrae, 1990, p. 370)and illustrates thecomplementary nature of measures of personality and psycho-pathology.

The PAI is a new instrument designed "to provide informa-tion on critical clinical variables" (Morey, 1991, p. 1). In addi-tion to 11 clinical scales (most with subscales), it also containsfour validity scales, two interpersonal scales, and five scalesrelated to treatment and case management. Table 3 providesmeans, standard deviations, and coefficients alpha for the PAIclinical and treatment scales, aswellascorrelations with NEO-PI domain scales. Comparison of means shows that the presentsample is similar to the normative group of normals in mostrespects. Internal consistencies are high except for the DrugProblems and Stress scales, which show relativelylittle variancein this predominantly older sample.

Correlations of the clinical scales with the NEO-PI domainsshow a pattern previously seen in analyses of the MMPI andMCMI. Borderline Features, Anxiety, and Schizophrenia arestrongly related to N; Mania is related to E; Paranoia and Anti-social Features are negatively related to A, and none of thescales is strongly related to O or C.

The inclusion of treatment scales is an interesting feature ofthe PAI. Aggression and Suicidal Ideation refer to characteris-tics of the individual that clinicians should attend to, although


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10 PAUL T. COSTA, JR., AN D ROBERT R. McCRAETable 2Correlations ofNEO Personality Inventory Domain Scales With Jackson'sBasic Personality Inventory (BPI) Scales (N = 109)

NE O Personality Inventory domainBPI scale Neuroticism Extroversion Openness Agreeableness Conscientiousness

HypochondriasisDepressionDenialInterpersonal ProblemsAlienationPersecutory IdeasAnxietyThinking DisorderImpulse ExpressionSocial IntroversionSelf DepreciationDeviation

.29**.32***-.48***.33***.1 2.29**.60***.07.33***.1 6.38***.26**

-.19*-.27**-.19*.05.1 2.00-.08.01.29***-.44***-.43***.02

-.02-.05-.45***.1 4.1 5-.03.06-.13.30***-.15-.35***.01

-.08-.18.1 8-.56***-.40***-.21*-.01.00-.16-.28**-.17-.17

-.17-.21*.21*-.07-.09-.07-.28**-.11-.36***-.04-.35***-.02* / > < . 0 5 . **p


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SPECIAL SECTION: NEO-PI IN CLINICAL PSYCHOLOGY 11not a world apart from dimensions o f personality; both arespanned by the same five dimensions.

Clinical Uses of Personality DataIn 1986 we argued that clinicians could benefit from routineassessment of the five basic factors of personality (McCrae &Costa, 1986). It seemed obvious to us that they would want tounderstand the enduring emotional, interpersonal, experien-tial, attitudinal, and motivational styles of their patients, justasthey need to consider age, sex, education, and cultural back-ground. It soon became clear to us, however, that more isneeded than a guide to the elements o f personality: Cliniciansalso need to learn how to use this information.No t surprisingly,many of the most important insights in this regard have comefrom practicing psychotherapists w ho have used the NEO-PIthemselves (Pagan et al, 1991; Miller, 1991; Muten, 1991). W esummarize some o f their experience here.

UnderstandingThe most basic function of psychological assessment is togive the clinician a sense of what the patient is like. Althoughself-reports are not infallible, there is considerable evidencethat the NEO-PI provides relatively accurate information o npatients from a varietyof clinical populations. Because the five-factor model is comprehensive, the profile the NEO-PI pro-vides coversthe full rangeof personality traits and can give theclinician a senseof both the patient's strengths and weaknesses.Knowledge o f personality traits can also set in context the spe-cific problems that led the patient to therapy: Are they reac-tions to recent events or difficult situations, or are they symp-toms of enduring and pervasive maladjustments?

DiagnosisNEO-PI scores maysuggest possible diagnoses or be used torule o ut various disorders. Elevated N scores are commonam ong patients in psychotherapy, but the particular facetso f Nthat are most elevated m ay focus attention on specific diag-noses. Very high Self-Consciousness scores, fo r example, shouldlead the clinician to consider the diagnosis ofSocial Phobia,which is distinguished by a persistent fear o f acting in a waythat will be humiliating o r embarrassing. Extreme scores onnormal personality traits are not necessarily an indication o fpsychopathology (e.g., a patient m ay be very extraverted with-o ut being histrionic), but extreme scores are often contraindica-tive of certain diagnoses (e.g., very high E scores are inconsis-

tent with the diagnosis of schizoid personality disorder).Empathy and Rapport

Patients wantto be understood, and they expect therapists tobe experts at understanding human nature. When therapistsare informed by NEO-PI results early in the therapeutic pro-cess, they appear more knowledgeableand empathic to the pa-tient, allowing a more rapid development of rapport. This isparticularly important in short-term therapy, in which sessionsspent learning about the patient m ay be time lost from treat-ment. Clinicians themselves m ay also find it easier to empa-

thize with patients when they consider nonpathological aspectsof personality, such as the individual's intellectual interests o rcapacity fo r joy.Feedback and Insight

Traditionally, the results of clinical assessments have been fo rtheeyesof the therapist only; it wasassumed that they wouldbeconfusing and upsetting to patients. Certainly, this is true fo rsome instruments and some patients. Bu t more recently, thevalue ofsharing test results has been emphasized; McReynolds(1989) has called this approach client-centered assessment.Clearly, it is easier to discuss with patients the results from ameasure of normal personality than from measures o f psycho-pathology, and a brief, nontechnical sheet, Your NE O Summary,has been developed to provide feedback to individuals whotake the NEO-PI or NEO-FFI. At least one clinician (Muten,1991) routinelyreviews the full profile sheet with patients, tak-ing the time toexplain the labels fo r the scalesand the interpre-tation o f normedscores; further, he refers back to this profile asrelevant issues arise in therapy. In this way, the scale scores aretied to concrete examples ofproblematic behavior to help thepatient achieve insight into his or her behavior. Research isneeded to establish the utility of this process and the patientpopulations fo r which it is appropriate, but clinical experiencetodate is encouraging.Anticipating th e Course of Therapy

The success ofpsychotherapy depends notonlyon the thera-pist's skill, but also on the patient's cooperation, motivation towork, and capacity fo r therapeutic benefit. Patients with defi-ciencies in these areas need special attention from the thera-pist, and the NEO-PI can signal potential problems in theseareas. Scores on A are particularly relevant to issues of trust andcooperation. The patient with very low A scores m ay be skepti-cal about the entire therapeutic enterprise and expect the clini-cian to prove him- or herself. Conversely, excessively high Ascores can point to an overly compliant patient who easily be-comes dependent on the therapist.Many kinds of therapy require that the patient dosome formof homework between sessions (e.g., record dreams, chart eatingbehaviors, keep a diary of emotional reactions). As in academicsettings, some people are more prone to take such assignmentsseriously than others are, and this is gauged chiefly by C. Pa-tients who are very low in C m ay not even remember to keeptherapy appointments. Law C scores can alert the clinician tothe need to provide structure and motivation for the patient.Finally, scores on N are prognostic of ultimate outcome. Pa-tients who are relatively well-adjusted to begin with are thosewho benefit most from therapy. In the case of extremely high Nscores, the clinician needs to foster realistic expectations aboutthe benefits of therapy. No form of therapy is likely to affect acomplete cure o f lifelong dysthymia o r a borderline personalitydisorder; instead, thegoal oftherapy may be to limit distressorteach the patient how to manage it. Personality dispositionsand the disorders to which they predispose individuals tend tobe very stable in adulthood; clinicians should measure progress


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12 PAUL T. COSTA, JR., AND ROBERT R. McCRAEagainst this standard, rather than against the often unrealisticstandard of perfect mental health (Costa & McCrae, 1986).Matching Treatments to Patients

Therapists have known fo r decades that some treatmentswork better with some patients than with others. The medicalmodel suggests that the diagnosis should dictate the treatment,but this model isoften inapplicable topsychotherapy. Researchon the differential effectiveness of different kinds o f therapyhas emphasized patient characteristics such as gender and so-cial class (Garfield, 1978) and has offered only limited insights.We believe that a consideration of personality traits may bemore fruitful.The two dimensions of clearest relevance to the choice oftherapies are E and Q Extraverts are sociable, talkative, anddemonstrative, and will find therapies that require interper-sonal interaction congenial. Miller (1991) has noted that bothclient-centered therapy and psychoanalysis require consider-able spontaneous speech from the patient and are difficult fo rintroverts. By contrast, low-E patients m ay prefer and benefitmo re from behavior therapy orGestalt, inwhich the therapisthas a more active role. Shea (1988) has shown that interperson-ally involved depressed patients benefit more from interper-sonal therapy; detached patients benefit more fromantidepres-sant medications.It isalso reasonable tohypothesize that differences in O willaffect the patient's response to therapy. Individuals who areclosed toexperience areconventional intheir tastesand beliefs,and they will probably prefer directive psychotherapies thatoffer sensible advice, behavioral techniques that teach concreteskills, or client-centered therapies that provide emotional sup-port. Patients who are high in O are much more willing toconsider novel ideas and to try out unusual approaches to prob-lem solving. Gestalt, psychoanalysis, or Jungian analysis m ayappeal to them.It is certainly true that whatthe patient prefers is no t necessar-ily what the patient needs: Group therapy m ay be exactly whatan avoidant introvert requires. But the clinician w ho under-stands the enduring dispositions of the patient will be in amuch better position toselect a treatment and toexplain to thepatient why it is needed and how it should work. This is an areain which much more research is needed, and the five-factormodel provides a comprehensive framework within which toconduct research on the relation o f individual differences totreatment outcomes.

ReferencesBlock, J. (1981). Some enduring and consequential structures of per-sonality. In A. I. Rabin, J. Aronoff, A. M. Barclay, & R. A. Tucker

(Eds.), Further explorations in personality (pp. 27-43). New York:Wiley-Interscience.

Cattell, R. B., Eber, H. W, & Tatsuoka, M. M. (1970). The handbook forthe Sixteen Personality Factor Questionnaire.Champaign, IL: Insti-tute for Personality and Ability Testing.Costa, P. T, Jr., & McCrae, R. R. (1980). Still stableafter all theseyears:Personality as a key to some issues inadulthoodand old age. In P. B.Baltes & O. G. Brim, Jr. (Eds), Life span development and behavior(Vol. 3, pp. 65-102). New York: Academic Press.

Costa, P. X, Jr., &McCrae, R. R. (1985). The NEO Personality Inventorymanual. Odessa, FL: Psychological Assessment Resources.Costa, P.T., Jr., & McCrae, R. R. (1986). Personality stability and its

implications fo r clinical psychology. Clinical Psychology Review, 6,407-423.Costa, P.T., Jr., & McCrae, R. R. (1988). Personality in adulthood:Asix-year longitudinal study ofself-reports and spouse ratingson the

NE O Personality Inventory. Journal of Personality and Social Psy-chology, 54, 853-863.Costa, P. X, Jr., &McCrae, R. R. (1989). The NEO-Pl /NEO-FFI man-ual supplement. Odessa, FL: Psychological Assessment Resources.Costa, P. X, Jr., &McCrae, R. R. (1990).Personalitydisorders and thefive-factor model of personality. Journal of Personality Disorders, 4,362-371.Costa, P. X, Jr., & McCrae, R. R. (in press-a). Manual for the RevisedNE O Personality Inventory (NEO-PIR) and NEO Five-Factor Inven-

tory (NEO-FFI). Odessa, FL: Psychological Assessment Resources.Costa, R X, Jr., &McCrae, R. R. (in press-b). Multiple uses for longitu-

dinal personality data. European Journal of Personality.Costa, P. X, Jr., & McCrae, R. R. (in press-c). The NEO PersonalityInventory. In S. R. Briggs & J. Cheek (Eds.), Personality measures(Vol. 1). Greenwich, CT: JA I Press.Costa, P. X, Jr., McCrae, R. R., & Dye, D. A. (1991). Facet scales for

Agreeableness and Conscientiousness: A revision of the NEO Per-sonality Inventory. Personality and Individual Differences, 12 , 887-898.Digman, J. M. (1990). Personality structure: Emergence of the five-fac-

tor model. Annual Review of Psychology, 41, 417-440.Digman, J.M., &Xakemoto-Chock, N. K. (1981). Factors in the natu-

ral language of personality: Re-analysis, comparison, and interpre-tation of six major studies. Multivariate Behavioral Research, 16,149-170.

Eysenck, H. J. (1962). The Maudsley Personality Inventory. San Diego,CA: EdITS.

Pagan, P. J., Wise, T. N, Schmidt, C. W, Ponticas, Y, Marshall, R. D.,&Costa, P X, Jr. (1991). A comparison of five-factor personality di-mensions in males with sexual dysfunction and males with para-philia. Journal of Personality Assessment, 57 , 434-448.Funder, D. C. (1991).Global traits: ANeo-Allportian approach to per-sonality. Psychological Science, 2, 31-39.Garfield, S. L. (1978). Researchonclient variables in psychotherapy. InS. L. Garfield & A. E. Bergin (Eds.), Handbook of psychotherapy andbehavior change:An empirical analysis (2nd ed.; pp. 19 1 -232). NewYork: Wiley.Gough, H. G. (1957). California Psychological Inventory manual. PaloAlto, CA: Consulting Psychologists Press.Guilford, J. S., Zimmerman, W S., & Guilford, J. P. (1976). The Guil-ford-Zimmerman Temperament Survey Handbook: Twenty-five yearsof research and application. San Diego, CA: EdITS.Hathaway, S. R., & McKinley, J. C. (1983). The Minnesota MultiphasicPersonality Inventory manual. New \brk: Psychological Corpora-tion.Hirschfeld, R. M. A., Klerman, G. L., Clayton, P., Keller, M. B.,McDonald-Scott, P., & Larkin, B.(1983). Assessing personality: Ef-fects of depressive state of trait measurement. American Journal ofPsychiatry, 140, 695-699.

Hirschfeld, R. M. A., Klerman, G. L., Lavori, P, Keller, M. B., Grif-fith, P., &Coryell, W (1989). Premorbid personality assessments offirst onset of major depression. Archives of General Psychiatry, 46,345-350.

Hogan, R. (1989). [Review of The NEO Personality tinattory]. In J. C.Conoley & J. J. Kramer (Eds), The tenth mental measurements year-book. Lincoln, NE: Buros InstituteofMental Measurements.Horney, K.. (1945). Ou r innerconflict's. Ne w York: Norton.


9/9

SPECIAL SECTION: NEO-PI IN CLINICAL PSYCHOLOGY 13Jackson, D. N. (1989). BasicPersonality Inventory manual.Port Huron,

MI: Sigma Assessment Systems.John, O. P. (1990). The "big five" factor taxonomy: Dimensions of

personality in the natural language and in questionnaires. In L. Per-vin (Ed.), Handbook of personality theory and research. New York:Guilford.

Kenrick, D. X, & Funder, D. C. (1988). Profiting from controversy:Lessons from the person-situation debate. American Psychologist,43, 23-34.

Leong,F. T.L,&Dollinger, S. J. (1990). NEO Personality Inventory. InD. J.Keyser &R. C. Sweetland (Eds.), Test critiques (Vol. 8; pp. 527-539). Austin,TX: PRO-ED

Liebowitz, M. R., Stallone, F., Dunner, D. L,& Fieve, R. F. (1979).Personality features ofpatients with primary affective disorder. AdaPsychiatrica Scandinavica, 60, 214-224.

Lyons, M. I, Merla, M. E, Ozer, D.J,& Hyler, S. E. (1990, August).Relationship of the "big-five" factors to DSM-IH personality dis-orders. Paper presented at the98th Annual Conventionof theAmeri-can Psychological Association, Boston.

McCrae, R. R. (1986). Well-being scales do not measure social desir-ability. Journal of Gerontology, 41, 390-392.

McCrae, R. R. (1989). Why I advocate the five-factor model: Jointanalyses of the NEO-PI and other instruments. In D. M. Buss & N.Cantor (Eds.), Personality psychology: Recent trends and emergingdirections (pp. 237-245). New York: Springer-Verlag.

McCrae, R. R. (1990). Controlling neuroticism in the measurement ofstress. Stress Medicine, 6, 237-241.

McCrae, R. R. (1991). The five-factor model and its assessment inclinical settings. Journal of Personality Assessment, 57, 399-414.

McCrae, R. R.,& Costa, P. X, Jr. (1983). Social desirability scales:Moresubstance than style. Journal of Consulting and Clinical Psychology,51, 882-888.

McCrae, R.R,&Costa, P. T, Jr. (1985). Openness to experience. In R.Hogan & W H. Jones (Eds.), Perspectives in personality (Vol . 1; pp.145-172). Greenwich, CT: JA I Press.

McCrae, R. R., &Costa, P. X, Jr. (1986). Clinical assessment can bene-fit from recent advances in personality psychology. American Psy-chologist, 41,1001-1003.

McCrae, R. R., & Costa, P. X, Jr. (1989). Different points of view:Self-reports and ratings in the assessment of personality. In J. P.Forgas& J. M. Innes (Eds.), Recent advances in social psychology: Aninternational perspective (pp. 429-439). Amsterdam: Elsevier.

McCrae, R. R., &Costa, P. X, Jr. (1990). Personality inadulthood. NewYork: Guilford.McCrae, R. R., &Costa, P. X, Jr. (1991). The NEO Personality Inven-

tory: Using the five-factor model in counseling. Journal of Counsel-ing and Development, 69, 367-372,375-376.McCrae, R. R, &Costa, P. X, Jr. (in press). Conceptions and correlates

ofOpenness toExperience. In S. R. Briggs, R. Hogan, & W H. Jones(Eds.), Handbook of personality psychology. New \brk: AcademicPress.

McCrae, R. R., Costa, P. X, Jr., Dahlstrom, WG, Barefoot, J. C,Siegler, I.C,&Williams, R. B, Jr. (1989). Acautionon the use of the

MMPI / -correction in research onpsychosomatic medicine. Psycho-somatic Medicine, 51, 58-65.McReynolds, P. (1989). Diagnosis and clinical assessment: Current sta-

tus and major issues. AnnualReview of Psychology, 40, 83-108.Miller, X (1991). The psychotherapeutic utility of the five-factor

model ofpersonality: Aclinician's experience. Journal of PersonalityAssessment, 57, 415-433.

Millon, T. (1983). Millon Clinical Multiaxial Inventory manual(3rd.ed.). Minneapolis, MN: Interpretive Scoring Systems.Morey, L. (1991). Personality Assessment Inventory: Professional man-

ual. Odessa, FL: Psychological Assessment Resources.Muten, E.(1991).Self-reports, spouse ratings,and psychophysiological

assessment ina behavioral medicine program: An application of thefive-factor model. Journal of Personality Assessment, 57, 449-464.

Norman, W X (1963). Toward an adequate taxonomy of personalityattributes: Replicated factor structure in peer nomination personal-ityratings. Journal of Abnormaland Social Psychology, 66,574-583.

Piven, J,Landa, R., Wzorek, M., Gayle, J,Costa, P. X, Jr., Boulton, P.,Cloud, D.,Chase, G, &Folstein,S. (1990). Personality characteristicsof the first degree relatives of autistic individuals. Manuscript submit-ted for publication.

Shea, M. X (1988, August). Interpersonal styles and short-term psycho-therapy for depression. Paper presented at the 96th Annual Conven-tion of the American Psychological Association, Atlanta, GA.

Shock, N. W, Greulich, R.C,Andres,R,Arenberg, D,Costa, P. X, Jr.,Lakatta, E. G, & Xobin, J. D. (1984). Normal human aging: TheBaltimore Longitudinal Study of Aging (NIH Publication No. 84-2450). Bethesda, MD: National Institutes of Health.

Spielberger, C. D. (Chair). (1989, April). Use of the five-factor model inclinical assessment. Symposium presented at the 1989 MidwinterMeeting of the Society for Personality Assessment, NewYork.

Xellegen, A. (in press). Personality traits: Issues of definition, evidenceand assessment. In D. Cicchetti & W Grove (Eds.), Thinking clearlyabout psychology: Essays in honor of Paul Everett Meehl. Minneapo-lis: University of Minnesota Press.

Underwood, B., Froming, W J., &Moore, B. S.(1980). Mood and per-sonality: Asearch for the causal relationship. Journal of Personality,48,15-23.

Widiger, X A., &Trull, T. J. (in press). Personality and psychopathol-ogy: An application of the five-factor model. Journal of Personality.

Wiggins, J. S, & Pincus, A. L. (1989). Conceptions of personality dis-orders and dimensions of personality. Psychological Assessment: AJournal of Consulting and Clinical Psychology, 1, 305-316.

Wiggins, J. S., & Xrapnell, P. D. (in press). Personality structure: Thereturn of the big five. In S. R. Briggs,R. Hogan, & W H. Jones(Eds.),Handbook of personality psychology. New \brk: Academic Press.

Wrobel, X A., & Lachar, D. (1982). Validity of the Wiener subtle andobviousscales fo r theMMPI: Another exampleof the importanceofinventory-item content. Journal of Consulting and Clinical Psychol-ogy, 50, 469-470.

Received March 4,1991Revision received March 20,1991Accepted March 20,1991

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