Oral presentation at the annual North American Society for the Study of Personality Disorders conference in Pittsburgh

1. Construction & Development of
a Self-report Measure of
Subjective Emptiness
1Stephanie L. Price, 1Heike I.M. Mahler, 2Christopher J. Hopwood
1California State University San Marcos, 2University of California, Davis

2. Acknowledgments
Special thanks to the subject matter experts who evaluated the content
validity of the Subjective Emptiness Scale (SES) and to Marie Thomas in
the Department of Psychology at California State University San Marcos
for suggestions regarding the content of this document. This research
was supported in part by a grant from the National Institute of General
Medical Sciences (NIH/NIGMS).

3. Associated with various forms of
psychopathology
• Depression
• Anxiety
• Agoraphobia
• Schizophrenia
• Eating disorders
• Personality disorders
• Narcissistic
• Antisocial
• Borderline
• greater impairment across the broadest range of psychosocial domains
• one of the slowest remitting symptoms

4. Significant psychosocial impairement
• High risk complications
• Self-harm
• Suicidality
• higher rates of psychiatric hospitalization
• Addiction
• Sexual compulsivity
• Substance use
• Daily problems
• emotion dysregulation
• social dysfunction
• problems with identity and self-concept
• absenteeism at work
• reliance on disability benefits

5. Treatment resistant
•preliminary evidence supports efficacy of:
• electroconvulsive therapy
• group schema therapy
•lack of efficacy found for:
• all pharmacological interventions
• most psychotherapeutic approaches

6. Limitations of existing measures
•single items from instruments designed to measure BPD
• less reliable than multi-item scales
•multi-item measures
• inadequete evidence of construct validity
• ostensible construct irrelavent variance

7. Mixed method construct validation approach (Leovinger,
1957)
Qualitative stage
• Phase 1 - definition
• item generation
• literature review
• thematic analysis
• interviews
• content validity
• item reviews by experts and patients

8. Phase 1: Inductive + deductive item generation
*Borderline, narcissistic, antisocial, schizoid, avoidant, and schizotypal personality disorders
Method Personality
Disorders*
Mood Disorders Schizophrenia/
Psychotic disorders
Anxiety
Disorders
PTSD
Literature review X X X X
Thematic analysis (e.g.
Psych Forums)
X X X
Phenomenological
Interviews (n = 18)
X X X X X

9. Emptiness conceptualization & table of specifications
• INTERNAL: a state of profound hollowness (33%)
• EXTERNAL: disconnection from the external world (33%)
• PERVASIVE: chronic unfulfillment (33%)
Phase 1: Inductive + deductive item generation

10. Phase 1: Content validity survey
Sample
• Subject matter experts (n = 13)
• Interviewees from previous study (n = 10)
Procedure
•Rated each item according to its content relevance (CVR; Lawshe,
1975)
•Edit and suggest new items
•Qualitative feedback

12. Phase 1: Content validity survey
Sample
• Subject matter experts (n = 13)
• Interviewees from previous study (n = 10)
Procedure
•Rated each item according to its content relevance (CVR; Lawshe, 1975)
•Edit and suggest new items
•Qualitative feedback
Results
•Experts (95.45%) and patients (93.18%) reliabily rated most of the items as useful
•Inclusion of construct irrelevant content
•Better content domain coverage

13. Mixed method construct validation approach (Leovinger,
1957)
Qualitative stage
• Phase 1 - definition
• item generation
• literature review
• thematic analysis
• interviews
• content validity
• item reviews by experts and patients
Quantitative Stage
• Phase 2 - internal structure
• Dimensionality
• PCA
• CFA/IRT
• Homogeneity
• Internal consistency

14. Phase 2: PCA
•Participants: Sample 1 (n = 543)
•417 women, 126 men
•18 to 46 years, M = 20.22, SD = 3.17
•44.5% were Hispanic/Latino, 26.7% Caucasian, 14.3% Asian/Pacific
Islander, 10.8% Other, and 3.1% African-American
•Thirty-five (6.4%) reported taking psychiatric medication and 39
participants (7.2%) attended therapy.

15. Phase 2: PCA
53-item model
• Sample 1
• Kaiser-Meyer Olkin measure of sampling adequacy suggested that sample 1 was factorable (KMO = .97) and Bartlett's test
of sphericity was significant (X2 (1,378) = 19,630.09, p < .001)
• Loadings from this model ranged from .48 to .83
• First component accounted for 48.63% of the total item covariance
17-item model
• Sample 1
• Kaiser-Meyer Olkin measure of sampling adequacy suggested that the data were factorable (KMO = .96) and Bartlett's test
of sphericity was significant (X2 (136) = 5,826.63, p < .001)
• Loadings from this model ranged from .69 to .84
• First component accounted for 55.53% of the total item covariance

16. Phase 2: CFA & Internal consistency
• Participants: Sample 2 (n = 1,067)
• 716 women, 342 men
• 18 to 77 years old (M = 29.78, SD = 11.49)
• 81.8% Caucasian, 7.6% Other, 4.1% Hispanic/Latino,
3.2% Asian/Pacific Islander, and 2.2% African-American
• 42.3% completed some college, 25.1% possessed a
bachelor’s degree, 15.3% earned a high school
diploma/G.E.D., 13.2% earned a postgraduate degree,
and 3.7% did not graduate from high school
• Six-hundred and ninety-three (64.9%) reported taking
psychiatric medication and 520 participants (48.7%)
attended therapy
• Participants: Sample 3 (n = 1,016)
• 572 women, 403 men, and 39 other
• 18 to 76 years old (M = 27.50, SD = 10.13)
• 81.5% Caucasian, 6.9% Other, 5.0% Asian/Pacific
Islander, 4.1% Hispanic/Latino, and 2.0%
African-American o
• 41.4% had completed some college, 22.9% possessed a
bachelor’s degree, 18.4% earned a high school
diploma/G.E.D., 12.5% earned a postgraduate degree,
and 4.3% did not graduate from high school
• Five-hundred and three (49.5%) participants reported
taking psychiatric medication and 397 participants
(39.1%) attended therapy

17. Model 1 (Sample 2)

18. Model 2 (Sample 2)

19. Model 3 (Sample 2) α = .91

20. Model 3 replication (Sample 3) α = .93

21. •Phase 2: IRT for polytomous items

22. •Phase 2: IRT for polytomous items

23. Phase 2: IRT for polytomous items

24. Phase 2: IRT for polytomous items

25. Phase 2: IRT for polytomous items

26. Mixed method construct validation approach (Leovinger, 1957)
Qualitative stage
• Phase 1 - definition
• item generation
• literature review
• thematic analysis
• interviews
• content validity
• item reviews by experts and patients
Quantitative Stage
• Phase 2 - internal structure
• Dimensionality
• PCA
• CFA/IRT
• Homogeneity
• Internal consistency
• Phase 3 - associations
• Extreme groups validity
• Convergent and discriminant validity

27. Phase 3: Extreme groups validity
Figure 2. Student participants scored significantly lower across all seven items than clinical participants in samples two,
F (7, 1,575) = 117.20, p < .001; Wilk's Λ = 0.658, partial η2 = .34, and three, F (7, 1,533) = 126.38, p < .001; Wilk's Λ =
0.634, partial η2 = .37

28. Phase 3: Convergent & discriminant validity
Samples 1 and 2 measures
• The Zanarini Rating Scale for
Borderline Personality Disorder
• Sample 1 α = .82
• Sample 2 α = .83
• The Purpose in Life test short form
• Sample 1 α = .83
• Sample 2 α = .85
• The Barratt Impulsiveness Scale–Brief
• Sample 1 α = .72
• Sample 2 α = .84
• The Center for Epidemiologic Studies
Short Depression Scale
• Sample 1 α = .81
• Sample 2 α = .83

29. Phase 3: Convergent & discriminant validity
Sample 3 measures
• The Self-concept and Identity Measure
• Internal consistency of the SCIM instrument (α = .92)
• identity disturbance subscale (α = .88),
• identity consolidation subscale (α = .83)
• lack of identity subscale (α = 0.89)
• The Personality Inventory for DSM-5 Short Form

33. Conclusion
Strengths
•Large samples
•Multiple samples
•Rigorous content validity testing
•Numerous discriminant and
convergent measures
Weaknesses
•High dropout in clinical samples
•Lack of ethnic diversity

34. Implications
•Brief, unidimensional measure, the Subjective Emptiness Scale (SES)
•Useful for future research

35. Key Points
•The Subjective Emptiness Scale (SES) is brief 7-item self-report
measure of emptiness
•High internal consistency
•Unidimensional
•Strong evidence of construct validity
• Extreme groups
• Discriminant
• Convergent

36. References
Loevinger, J. (1957). Objective tests as instruments of psychological
theory. Psychological Reports, 3(3), 635-694.

38. Table 4. Correlations between 7-item Subjective Emptiness Scale (SES) and
validation measure scores among sample 3.
PID-5
Scale Correlation Scale Correlation
Anhedonia .80** Irresponsibility .27**
Anxiousness .39** Manipulativeness .06
Attention seeking -.07*
Perceptual
dysregulation
.40**
Callousness .19** Perseveration .38**
Deceitfulness .18** Restricted affectivity .21**
Depressivity .80** Rigid perfectionism .24**
Distractibility .26** Risk taking .11**
Eccentricity .31** Separation insecurity .26**
Emotional lability .35** Submissiveness .18**
Grandiosity .08* Suspiciousness .43**
Hostility .29**
Unusual beliefs and
experiences
.25**
Impulsivity .18** Withdrawal .42**
Intimacy avoidance .29**
Self-Concept and Identity Measure (SCIM)
Total .61** Identity disturbance .35**
Lack of identity .77**
Identity
consolidation
-.48**
Note: * Significant at p = .05; ** significant at p = .01