Linguistic and psychometric validation of the Ukrainian translation of "The inventory of personality organization-revised" (IPO-R-UKR)

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Ukrainian Catholic University

Linguistic and psychometric validation of the Ukrainian translation of «The inventory of personality organization-revised» (IPO-R-UKR)

Iryna Semkiv, Khrystyna Turetska,

Iryna Kryvenko, Roman Kechur

Abstract

The cultural adaptation of the psychodiagnostic questionnaire involves the implementation of a “double-blind” translation with subsequent linguistic validation considering both linguistic differences and the symbolism of the authors' statements. Then, based on the survey data of respondents, various psychometric indicators of the questionnaire are checked. The development of Ukrainian-language questionnaires in the psychodynamic paradigm is crucial for creating an appropriate scientific evidence base of therapeutic methods and for psychotherapeutic practice to equip specialists with reliable diagnostic tools. The research objective is to carry out a professional translation of The Inventory of Personality Organization-Revised (IPO-R) into Ukrainian, followed by checking for linguistic validity and psychometric properties. The questionnaire showed high psychometric performance in the long (IPO; Lenzenweger et al., 2001) and short (IPO-R; Smits et al., 2009) versions and foreign language adaptations. It is widely used in psychological research, the theoretical and methodological basis of which is the psychoanalytic concept, in particular, the theory of Kernberg (1986) on different levels of structural organization of personality, which underlies the psychoanalyst's choice of a strategy for working with a client. The created test version of the IPO-R-UKR questionnaire passed the stages of two-sided "double-blind" translation and was agreed upon by a team of philologists and psychologists. Based on the results of 1152 people participating in the empirical research, we have proven IPO-R-UKR to have a similar to the original two-factor structure, good internal consistency of the scales, construct convergent, and criterion validity. Thus, IPO-R-UKR can be used in practical psychological activities and scientific research to identify criteria for the structural organization of personality, such as reality testing, identity diffusion, and mechanisms of psychological defenses, as well as for screening diagnostics of the structural level of personality organization by Kernberg (1986).

Keywords: linguistic validity, Ukrainian translation, structural personality organization, identity diffusion, reality testing, defense mechanisms, psychodynamic therapy.

Семків Ірина, Турецька Христина, Кривенко Ірина, Кечур Роман. Лінгвістична та психометрична валідація україномовного перекладу «The Inventory of Personality Organization-Revised» (IPO-R-UKR).

Анотація

Культурна адаптація психодіагностичного опитувальника передбачає здійснення двостороннього “сліпого” перекладу із подальшою лінгвістичною валідацією, коли при перекладі враховуються як мовні відмінності, так і символізм авторських тверджень. Далі на основі даних опитування респондентів здійснюється перевірка різних психометричних показників отриманої мовної версії методики. Створення україномовних опитувальників у психодинамічній парадигмі є надважливим завданням для створення належної науково-доказової бази терапевтичних методів, що ґрунтуються на ній, так само як і для психотерапевтичної практики задля “озброєння” фахівців надійним діагностичним інструментарієм. Метою дослідження є здійснення фахового перекладу психологічного тесту «The Inventory of Personality Organization-Revised (IPO-R)» українською мовою, з подальшою перевіркою лінгвістичної валідності та психометричних показників тесту. Опитувальник продемонстрував високі психометричні показники у повній (IPO; Lenzenweger et al., 2001) та скороченій (IPO-R; Smits et al., 2009) версіях, а також в іншомовних адаптаціях. Він широко застосовується у психологічних дослідженнях, теоретико-методологічну основу яких складає психоаналітична концепція, зокрема, теорія О. Кернберга (Kernberg, 1986) про різні рівні структурної організації особистості, що лягає в основу вибору психоаналітиком стратегії роботи з клієнтом. Створений тестовий варіант опитувальника IPO-R-UKR пройшов етапи подвійного двостороннього “сліпого” перекладу та узгоджений групою філологів та психологів. Базуючись на результатах опитування 1152 учасників емпіричного дослідження, було доведено ідентичну оригінальній двофакторну структуру IPO-R-UKR, а також хорошу внутрішню узгодженість шкал, конструктну, конвергентну та критеріальну валідності. Отже, методику IPO-R-UKR можна використовувати у практичній психологічній діяльності, та наукових дослідженнях, спрямованих на виявлення критеріїв структурної організації особистості, як тестування реальності, дифузність ідентичності, механізми психологічного захисту, та для скринінгової діагностики рівня структури організації особистості за О.Кернбергом (1986).

Ключові слова: лінгвістична валідність, україномовний переклад, структурна організація особистості, дифузність ідентичності, тестування реальності, механізми психологічного захисту, психодинамічна терапія.

Introduction

The translation of psychodiagnostic tools is a complex task involving finding a linguistic equivalent of foreign words in the native language and accounting for latent meanings embedded in these words by the test authors. In the case of psychological tools translation, it is crucial to find the correct equivalent for metaphors, idioms, and latent symbolic meanings in a native language (ITC, 2017). In addition, this procedure should be accompanied by verification of the questionnaire's validity and reliability, which determine its cultural adaptation. This procedure requires the involvement of experts in both philology and psychology. Thus, cultural adaptation of psychological tests comprises qualitative (linguistic validation) and quantitative methods (statistical validation) (ITC, 2017; Borsa et al., 2012). Several issues in the cultural validation of psychological instruments in the healthcare field should be solved: linguistic, procedural, and cultural (Chatzidamianos et al., 2021). The last issue refers to both cultural background and to the symbolic meaning of the words in different languages and the psychological tool's author style (Meier et al., 20 21).

The article describes the linguistic and psychometric validation procedure of the Inventory of Personality Organization - Revised (IPO-R) (Smits et al., 2009), followed by cultural modification. Creating such a Ukrainian-language tool is an essential task for the development of psychodynamic practice in Ukraine and the investigation of the scientific bases of psychodynamic theory. Correct diagnosis is crucial for choosing the most effective psychotherapeutic interventions in a psychodynamic approach. The vector of modern psychodynamic analysts' activity is directed to the field of metric assessment of the personality organization, which gives a new problem representation, different from its former phenomenological perspective. Therefore, psychometric tools for measuring the personality's structural characteristics have a practical and scientific value.

One of the first models for assessing and diagnosing the personality organization with measurable indicators is the structural interview of Otto Kernberg. Based on Freud's structural theory of personality, Kernberg (1986) developed a method of structural analysis as an approach to psychoanalytic diagnostics. He introduced the criteria for determining the structural organization, a specific combination of which characterizes the three levels of personality organization - psychotic, borderline, and neurotic.

Reality testing is the primary criterion for distinguishing the psychotic level of a personality structural organization from the borderline and neurotic. It can be described through the ability to distinguish between self and non -self; between intrapsychic experiences and experiences originating from the outside world; the ability to evaluate one's emotions, behavior, and thoughts in terms of the social norms (Kernberg, 1986).

The degree of personality integration is another important criterion for distinguishing the levels of personality organization. Weak personality integration or the so-called identity diffusion is inherent in psychotic and borderline organizations, while the neurotic personality has a well-integrated identity. The integration of personality reflects the ability to form a holistic image of oneself, self-concept, and, secondly, a holistic view of other people (Kernberg, 1986).

The third criterion is the maturity of the defense mechanisms. Individuals with a psychotic organization have the least mature primary defenses based on splitting.

Alternatively, mature defenses based on repression are typical for the neurotic structural organization (Kernberg, 1986).

Although it provides some metrics, the structural interview is based on the trusting oral interaction of two people. This tool has been changed and modified several times. One of these modifications is the basis for the self-report questionnaire - The Inventory of Personality Organization (Lenzenweger et al., 2001). The 57-item questionnaire assesses the level of personality functioning according to the described criteria, having a three-factor structure verified in both clinical and non-clinical samples (Lenzenweger et al., 2001; Igarashi et al., 2009). It also has shown strong connections with the measures of other clinical scales: self-harmful, anxiety, depression, and aggression (Vermote et al., 2009); paranoid and antisocial personality disorders (Yun et al., 2013); tendencies to commit violence against a relationship partner (Maneta et al., 2013). Identity diffusion and primitive defenses are associated with low levels of self-control in borderline personality disorder patients (Hoermann et al., 2005); with alienation, aggression, absorption, and stress response (Lenzenweger et al., 2012); with a disorganized attachment style (Goodman, Bartlett, & Stroh, 2013). IPO has also been used to indicate the effectiveness in randomized controlled trials while treating personality disorders (Arntz, & Bernstein, 2006).

During the last years, several new investigations of the connectedness of the structural characteristics of personality and public and mental health issues appeared. They prove correlations between IPO scales and verbalization ability, reflective function (Gorska, & Soroko, 2017), negative maternal behaviors (Ensink et al., 2017), depressive symptoms, rumination mediates (Kovacs et al. 2021), traits of emotional intelligence, and early traumatic experience (Espinosa, & Rudenstine, 2018), psychological flexibility and attachment style (Salande, & Hawkins, 2017), and internalized relational patterns (Soroko, & Cierpialkowska, 2018). The researchers studying how people cope with the COVID-19 pandemic and lock-down have found out that those who did not believe that the virus was life-threatening were more disposed to use maladaptive defense mechanisms than those who thought it was dangerous for life (Zajenkowska et al., 2021).

There is evidence that the researchers can effectively use IPO with adolescents (Biberdzic et al., 2017). Several IPO scales' specifications were recently designed (Dagnall et al., 2018, Horz-Sagstetter et al., 2021).

However, a strong correlation between the factors of identity diffusion and primitive defense mechanisms (r =.97; Lenzenweger et al., 2001) brought an idea to check for the validity of IPO's two -factor structure (Normandin et al., 2002). After testing this model, a short 41-item version of the questionnaire, The Inventory of Personality Organization-Revised (IPO-R), was developed (Smits et al., 2009). The IPO-R includes 11 items on the Reality Testing (RT) and 30 items on the primitive defenses / identity diffusion (PD / ID). The authors claim these factors are independent, having a low correlation rate (r =.62; Smits et al., 2009, p.226), and internally consistent (a=.85 for the RT and a=.90 for the PD / ID; Smits et al., 200 9, p.226), as well as highly correlated with the original IPO scales (.92 and.97, respectively, for the RT and PD / ID scales), which indicates minimal information loss (Smits et al., 2009, p. 226).

The IPO and IPO-R have been translated and adapted into numerous languages: Japanese (Igarashi et al., 2009), French (Normandin et al., 2002), Dutch (Berghuis et al., 2009), German (Zimmermann et al., 2013), Portuguese (Oliveira, & Bandeira, 2011), Italian (Preti et al., 2015), which allows intercultural research in the theoretical and conceptual field of psychoanalysis. However, there is no Ukrainian translation and cultural adaptation for none of the described test versions for studying the structural organization. The creation of a translation and further validation of the IPO-R-UKR is a significant step towards implementing such research in domestic psychology.

The aim and objectives of the study. Taking the practical and scientific value of the IPO-R-UKR, and the lack of reliable and valid Ukrainian-language tools for diagnosing personality organization into consideration, the research aims to translate IPO-R into Ukrainian and to verify its psychometric indicators. Namely, the tasks are to create a high-quality Ukrainian-language version of the IPO-R-UKR; to check for its linguistic validity; on the results of empirical data analysis in a non-clinical sample to check for the internal consistency of the translated test, its construct convergent and criterion validity; to verify the two- and three-factor structure of the IPO-R-UKR and to choose an optimal solution for the Ukrainian-language version of the questionnaire key.

Procedure and Participants

The adaptation of the Ukrainian version of the “The Inventory of Personality Organization - Revised” had several stages. Firstly, the items were translated into Ukrainian, with subsequent expert evaluation and reverse translation, to ensure linguistic validity. Secondly, the empirical data were collected to assess the fundamental psychometric indicators of the Ukrainian-language test version - the internal consistency of the statements, structural, construct convergent, and criterion validity. Thirdly, based on the obtained results, the final version of the IPO-R-UKR and the questionnaire key were formed.

One thousand one hundred fifty-two people took part in the empirical study, 241 men (20.92%) and 664 women, 247 respondents did not indicate their sex, with an average age of 27.94 years (Min = 18, Max = 50, SD = 9.18). The age distribution was characterized by right-sided asymmetry (Med = 25; Shapiro-Wilk W =.87770; p <.001). The participants were recruited via social media and after signing an informed consent each of them was randomly allocated to fill-in one of the Google- forms including IPO-R, as well as one or more questionnaires (for details, see below). We did not collect any personal information about the participants so that their anonymity could not be broken.

linguistic psychometric validation translation

Materials

The Ukrainian translation of IPO-R (Smits et al., 2009) that we have used, consists of 41 items to be assessed using a 5-point Likert scale (never = 0, rarely = 1, sometimes = 2, often = 3, always = 4). After checking for the questionnaire's factor structure (see below), the scores for the scales of reality testing (RT, 11 statements) and the defense mechanisms/identity diffusion were calculated in the range 0-100, according to their percentage values, due to the different number of the items in the scales.

We used the following measures to determine the construct convergent validity of IPO-R-UKR:

* The Bell's Object Relations & Reality Testing Inventory (BORRTI) (Bell, 1995) consists of 34 questions and contains 2 scales: “object relations” (24 items) and “reality testing” (10 items).

* The Personality Assessment Inventory - Borderline Scale (PAI-BOR) (Morey, 1991) contains 24 questions divided into the following scales: “affective instability,” “identity problems,” “negative attitudes,” and “self-harm.”

The links of IPO-R scales with the following questionnaires' scales were to assess criterion validity:

* Mentalization Questionnaire (MZQ) (Hausberg et al., 2012) contains 15 items which form four scales: “refusal of self-reflection,” “emotional awareness,” “mental equivalence mode,” “affect regulation.”

* The measure of Attachment Qualities (MAQ) (Carver, 1997) contains 14 questions and four scales - “safety,” “avoidance,” “ambivalent anxiety,” and “ambivalent self-absorption.” The questionnaire allows determining the leading type of attachment a person shows in social relationships in adulthood.

* The Hypersensitive Narcissism Scale (HSNS) (Hendin, & Cheek, 1997) diagnoses the level of vulnerable narcissism as a personality trait characterized by sensitivity to other people's views, avoiding behavior. The scale contains ten statements.

We have tested linguistic validity by the method of parallel double-blind translation, further expert evaluations of the text, and the method of reverse translation. Empirical data were processed in the STATISTICA 8.0 package. The methods of exploratory factor analysis - principal components analysis (EFA-PCA) verified structural validity, Cronbach's alpha method established reliability, and correlation analysis was to check for the construct convergent and criterion validity of the IPO-R- UKR.

Results

Linguistic Validity. While creating a test variant of the IRO-R-UKR, two professional philologists- translators have independently translated the original English version of IPO-R into Ukrainian. A group of experts, professional psychologists, and Ukrainian philologists have compared these texts to evaluate each item to have the most reasonable interpretation. The next step provided reverse translations by two native English speakers with fluency in Ukrainian. We have compared these versions with the original IPO-R to eliminate free interpretations of the text (Eremenco, Cella, & Arnold, 2005; Rebrii & Demetska, 2020). As a result, a test version of the IPO-R- UKR was formed, which we believe saves the content of the original items and accounts for the linguistic tradition of the Ukrainian language.

The analysis of both translations showed no significant differences in the wordings for more than half of the items (No. 3-6, 11-15, 17-18, 20, 24-25, 28, 30, 33-38, 40-41). However, some statements required more careful analysis. The least problematic were the differences, which indicated the synonymy of the words used by translators rather than the interpretation inaccuracies, which could affect the content of the question (Carl & Schaeffer, 2017). For example, Item No. 2, “When I'm nervous or confused, it seems like things in the outside world don't make sense either,” one of the translators formulated this item in Ukrainian as “When I feel nervous...” (“коли я нервую”), while another translator used the phrase “When I am nervous” (“коли я знервований”), thus, focusing on a process and an emotional state respectively. Such differences do not significantly affect the understanding of the content of the question. However, Ukrainian philologists believe the wording “коли я нервую” (the process) is more reasonable than the one describing a state. We also met this wording in Google-search more often: “коли я нервую” shows about 5,900 uses, while “коли я знервований” is met only 185 times. We found a similar pattern in item No. 21 “My life, if it were a book, seems to me more like a series of short stories written by different authors than like a long novel”. Translations of the word “book” into Ukrainian - “книга” or “книжка”, as well as “stories” - “історії” or “оповідання” were controversial, in both cases we preferred the first word for IPO-R-UKR test version.

Item No. 7, “I feel that my tastes and opinions are not really my own, but have been borrowed from other people,” also had differences in translation. Namely, one of the interpreters stated “.I inherit them from others” (“я їх переймаю від інших”), and the second formulated “.as if borrowed from others” (“наче запозичені від інших”).

For the final version of the questionnaire, based on similarities with the original, we chose the wording in the passive state “are borrowed from others” (“запозичені від інших”). According to the psychodynamic framework, this wording also has a more substantial diagnostic value for studying the maturity of the defense mechanisms. Knox (2011), analyzing William James' distinction between the two aspects of the self, “I” and “Me”, empathizes that “Me-ness” symbolizes the passive state of mind, and “I-ness” is a symbol for maturity and developed self-agency. People using words symbolizing high levels of self-agency in personal narratives are more likely to have secondary and more mature defenses. A similar challenge in translation arose for item No. 23. Item No. 23: “I pick up hobbies and interests and then drop them”. Two versions of the translation offered either active or passive form: “I find new hobbies..(“Язнаходжу хобі”) and “The hobbies appear... ” (“У мене з'являються хобі”). We preferred an active form, the same as used in the original (“Я знаходжу”), as more appropriate.

In item No. 8, “I feel that my wishes or thoughts will come true as if by magic,” the last part of the statement had different versions of the translation, namely “.will be performed by a miracle as if by magic” (“збудуться дивом, так ніби це магія”) and “...can be carried out in some magical way” (“можуть здійснитись якимось магічним чином”). To avoid tracing the linguistic construction from English, we chose a phrase which is more acceptable for Ukrainian, “здійснитись магічним чином”. For item No. 10, "I am not sure whether a voice I have heard or something that I have seen is my imagination or not," the similar challenge appeared. The more typical for Ukrainian “is the fruit of my imagination” (“є плодом моєї уяви” appears in the test version.

We have solved similar translation problems in items No. 26, 27, 31, 32, and 39 in the same way, following the Ukrainian language tradition rather than the word-to- word translation.

Item No. 9, “People tell me I provoke or mislead them so as to get my way,” includes a disputable wording which was translated as “mislead” (“ввожу в оману”) and “deceive” (“обманюю”) by two translators. Oppositely, in this case, we chose the first construction as both closer to the original and more common for Ukrainian. Item No. 16, “I can't tell whether certain physical sensations I'm having are real, or whether I am imagining them”” had controversial translations with a different context: “.or it's my imagination” (“це моя уява”) vs. “.I'm making them up” (“я їх вигадую”).

In our choosing correct wording, we proceeded from the logic that it is not that important for the questionnaire to emphasize the cognitive process of imagination than on the fact that the sensations may be wrong. As a result, we worded the following statement: “Я не можу сказати, чи деякі з моїх фізичних відчуттів переживаються мною реально, чи я їх вигадую ”.

Item No. 19, “People tend to use me unless I watch out for it,”” was also disputable. The two translators' versions were “unless I'm not careful with them” (“якщо я їх не остерігаюся””) vs. “unless I don't control” (“якщо я не контролюю”).

None of the wording fully reveals the essence of the issue. The first translator's version linking “watch out for it” to the need of a person to be careful, to beware (similarly to “watch out for danger”) looks more akin than an alternative one. However, the controversial phrase, we believe, refers more to the word “use,” and not the people who do it (as in the translation using a pronoun “them”). Therefore, the statement in Ukrainian sounds like “Люди мають схильність використовувати мене, якщо я за цим не стежу”.

We would also like to pay attention to the cultural specificity of several IPO -R items. Namely, the evaluation of the circumstances' predictability is essential here.

For instance, items No. 33, “My life goals change frequently from year to year,” or No. 18, “I act in ways that appear to others as unpredictable” (items No. 15 and 26 have the same ideas). Since the political and social situation in Ukraine is more unpredictable than in the USA or the EU, the measures of unpredictability and uncertainty avoidance can have a different value for the respondents.

Structural Validity. Using the EFA-PCA, we have divided all items into two and three factors to determine the more valid structure of the IPO-R-UKR.

Two-factor model. Two selected factors describe 38.92% of the total variance; the correlation between factors is significantly lower than in the original version: r =.26 vs. r =.62 reported by Smits et al. (2009, p.226) that indicates the factors' independence (Fig. 1).

Figure 1

The items ' location in the two-factor IPO-R-UKR structure

Factor Loadings, Factor 1 vs. Factor 2 Rotation: Varimax normalized Extraction: Principal components

Smits et al. (2009) decided to exclude the statement from the scale in case of its loading <.40 and/or cross-loading <.20. There are no cross-loadings for any statement (see Fig. 1), and the lowest factor load for item No. 38 is.399. According to the factor loading (see Table 1), the Ukrainian version completely replicates the original questionnaire's structure: factor 1 (PD / ID) includes 30 items, No. 1 -7, 9, 12, 14-15, 18-19, 21-23, 25-26, 28-39, and factor 2 (RT) consists of 11 statements, No. 8, 10-11, 13, 16-17, 20, 24, 27, 40-41. Thus, the two-factor model of IPO-R-UKR is valid.

Table 1

Factor loadings of the IPO-R-UKR items (EFA-PCA results)