Skip to main content

Dysfunctional cognitions in personality pathology: the structure and validity of the Personality Belief Questionnaire

  • J. C. Fournier (a1), R. J. DeRubeis (a2) and A. T. Beck (a3)

This study examines the structure of the Personality Belief Questionnaire (PBQ), a self-report instrument designed to assess dysfunctional beliefs associated with personality pathology, as proposed by the cognitive theory of personality dysfunction.


The PBQ was examined using exploratory factor analysis (EFA) with responses from 438 depressed out-patients, and confirmatory factor analysis (CFA) with responses from 683 treatment-seeking psychiatric out-patients. All participants were assessed for personality disorder (PD) using a standard clinical interview. The validity of the resulting factor structure was assessed in the combined sample (n=1121) by examining PBQ scores for patients with and without PD diagnoses.


Exploratory and confirmatory analyses converged to indicate that the PBQ is best described by seven empirically identified factors: six assess dysfunctional beliefs associated with forms of personality pathology recognized in DSM-IV. Validity analyses revealed that those diagnosed with a PD evidenced a higher average score on all factors, relative to those without these disorders. Subsets of patients diagnosed with specific DSM-IV PDs scored higher, on average, on the factor associated with their respective diagnosis, relative to all other factors.


The pattern of results has implications for the conceptualization of personality pathology. To our knowledge, no formal diagnostic or assessment system has yet systematically incorporated the role of dysfunctional beliefs into its description of personality pathology. The identification of dysfunctional beliefs may not only aid in case conceptualization but also may provide unique targets for psychological treatment. Recommendations for future personality pathology assessment systems are provided.

Corresponding author
*Address for correspondence: J. C. Fournier, Ph.D., University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA. (Email:
Hide All
Beck AT (1983). Cognitive therapy of depression: new perspectives. In Treatment of Depression: Old Controversies and New Approaches (ed. Clayton P. J. and Barrett J. E.), pp. 265290. Raven Press: New York.
Beck AT, Beck JS (1991). The Personality Belief Questionnaire. The Beck Institute for Cognitive Therapy and Research: Bala Cynwyd, PA.
Beck AT, Butler AC, Brown GK, Dahlsgaard KK, Newman CF, Beck JS (2001). Dysfunctional beliefs discriminate personality disorders. Behaviour Research and Therapy 39, 12131225.
Beck AT, Freeman A (1990). Cognitive Therapy of Personality Disorders. Guilford Press: New York.
Beck JS (1998). Complex cognitive therapy treatment for personality disorder patients. Bulletin of the Menninger Clinic 62, 170194.
Bentler PM (1990). Comparative fit indexes in structural models. Psychological Bulletin 107, 238246.
Blatt SJ, Shahar G, Zuroff DC (2001). Anaclitic (sociotropic) and introjective (autonomous) dimensions. Psychotherapy: Theory, Research, Practice, Training 38, 449454.
Bornstein RF (2011). Reconceptualizing personality pathology in DSM-5: limitations in evidence for eliminating dependent personality disorder and other DSM-IV syndromes. Journal of Personality Disorders 25, 235247.
Butler AC, Beck AT, Cohen LH (2007). The Personality Belief Questionnaire – Short Form: development and preliminary findings. Cognitive Therapy and Research 31, 357370.
Butler AC, Brown GK, Beck AT, Grisham JR (2002). Assessment of dysfunctional beliefs in borderline personality disorder. Behaviour Research and Therapy 40, 12311240.
Clark LA (2005). Temperament as a unifying basis for personality and psychopathology. Journal of Abnormal Psychology 114, 505521.
Clarkin JF, Huprich SK (2011). Do DSM-5 personality disorder proposals meet criteria for clinical utility? Journal of Personality Disorders 25, 192205.
Costa PT, Patriciu NS, McCrae RR (2005). Lessons from longitudinal studies for new approaches to the DSM-V: the FFM and FFT. Journal of Personality Disorders 19, 533539.
Doyle TJ, Tsuang MT, Lyons MJ (1999). Comorbidity of depressive illnesses and personality disorders. In Comorbidity in Affective Disorders (ed. Tohen M.), pp. 105156. Marcel Dekker, Inc.: New York.
First M, Gibbon M, Spitzer R, Williams J, Benjamin L (1997). Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). American Psychiatric Press, Inc.: Washington, DC.
First MB, Bell CC, Cuthbert BN, Krystal JH, Malison R, Offord DR, Reiss D, Shea T, Widiger TA, Wisner KL (2002). Personality disorders and relational disorders: a research agenda for addressing crucial gaps in DSM. In A Research Agenda for DSM-V (ed. Kupfer D. J., First M. B. and Regier D. A.), pp. 123200. American Psychiatric Association Press: Washington, DC.
Hamilton MA (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 5662.
Holgado-Tello FP, Chacón-Moscoso S, Barbero-García I, Vila-Abad E (2010). Polychoric versus Pearson correlations in exploratory and confirmatory factor analysis of ordinal variables. Quality and Quantity 44, 153166.
Hopwood CJ, Donnellan MB (2010). How should the internal structure of personality inventories be evaluated? Personality and Social Psychology Review 14, 332346.
Hu L-t, Bentler PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling 6, 155.
Kendler K, Kupfer D, Narrow W, Phillips K, Fawcett J (2009). Guidelines for making changes to DSM-5, revised 21 October 2009 (
Krueger RF, Eaton NR, Clark LA, Watson D, Markon KE, Derringer J, Skodol A, Livesley WJ (2011). Deriving an empirical structure of personality pathology for DSM-5. Journal of Personality Disorders 25, 170191.
Livesley WJ, Jackson DN (1992). Guidelines for developing, evaluating, and revising the classification of personality disorders. Journal of Nervous and Mental Disease 180, 609618.
Livesley WJ, Jang KL (2000). Toward an empirically based classification of personality disorder. Journal of Personality Disorders 14, 137151.
Marsh HW, Hau K-T, Wen Z (2004). In search of golden rules: comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler's (1999) findings. Structural Equation Modeling 11, 320341.
Millon T, Davis RO (1996). Disorders of Personality: DSM-IV and Beyond. John Wiley & Sons, Inc.: New York.
Mischel W, Shoda Y (1995). A cognitive-affective system theory of personality: reconceptualizing situations, dispositions, dynamics, and invariance in personality structure. Psychological Review 102, 246268.
Muthén LK, Muthén BO (2009). Mplus: Statistical Analysis with Latent Variables. User's Guide. Muthén & Muthén: Los Angeles, CA.
Shedler J, Beck A, Fonagy P, Gabbard GO, Gunderson J, Kernberg O, Michels R, Westen D (2010). Personality disorders in DSM-5. American Journal of Psychiatry 167, 10261028.
Skodol AE, Bender DS, Morey LC, Clark LA, Oldham JM, Alarcon RD, Krueger RF, Verheul R, Bell CC, Siever LJ (2011). Personality disorder types proposed for DSM-5. Journal of Personality Disorders 25, 136169.
Spitzer RL, Williams JBW, Gibbon M, First MB (1990). The Structured Clinical Interview for DSM-III-R Axis II Disorders (SCID-II). American Psychiatric Press, Inc.: Washington, DC.
Steiger JH, Lind JM (1980). Statistically based tests for the number of common factors. Paper presented at the Annual Meeting of the Psychometric Society, Iowa City, IA.
Trull TJ, Goodwin AH, Schopp LH, Hillenbrand TL, Schuster T (1993). Psychometric properties of a cognitive measure of personality disorders. Journal of Personality Assessment 61, 536546.
Tucker LR, Lewis C (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika 38, 110.
Verheul R, Widiger TA (2004). A meta-analysis of the prevalence and usage of the personality disorder not otherwise specified (PDNOS) diagnosis. Journal of Personality Disorders 18, 309319.
Westen D (1995). A clinical-empirical model of personality: life after the Mischelian ice age and the NEO-lithic era. Journal of Personality 63, 495524.
Westen D, Shedler J (2000). A prototype matching approach to diagnosing personality disorders: toward DSM-V. Journal of Personality Disorders 14, 109126.
Widiger TA, Clark LA (2000). Toward DSM-V and the classification of psychopathology. Psychological Bulletin 126, 946963.
Widiger TA, Simonsen E (2005). Alternative dimensional models of personality disorder: finding a common ground. Journal of Personality Disorders 19, 110130.
Yates A (1987). Multivariate Exploratory Data Analysis: A Perspective on Exploratory Factor Analysis. State University of New York Press: Albany.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 2
Total number of PDF views: 41 *
Loading metrics...

Abstract views

Total abstract views: 281 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th November 2017. This data will be updated every 24 hours.