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To identify PD prototypes, Shedler and Westen developed the SWAP-200, a Q-sort instrument designed for taxonomic research and assessment of personality pathology (We are currently norming the second edition of the instrument, the SWAP-II) In designing the SWAP, we drew substantially on the work of Block (1971, 1978), who pioneered both the use of Q-sort techniques for personality assessment and the development of personality prototypes in normal populations A Q-sort is a ranking procedure, in which the observer sorts items into piles, from least to most descriptive of the person (On the advantages and limitations of Q-sorts for measuring clinical descriptions, see Block, 1978) Following Block, our goal was to provide clinicians with a standard language with which to make their observations, so that we could use data from experienced clinical observers to generate reliable formulations of a case or disorder.

Participants with higher degrees of both self-efficacy and perceived control were able to tolerate the cold pressure task longer Discomfort tolerance was longest when both of these factors were high Similarly, Baker and Kirsch (1991) found selfefficacy to be a strong predictor of discomfort tolerance in a cold water task In this study, participants who used strategies to boost self-efficacy while immersing their hand in cold water for as long as possible showed increased discomfort tolerance, but did not report a decrease in perceived discomfort The effects of both self-efficacy and drugs on tolerating the discomfort of a cold pressure task were investigated by Bandura et al (1987) Participants were given either selfefficacy-related cognitive methods to cope with discomfort tolerance, a placebo, or no intervention control.

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The SWAP presumes a clinically experienced observer, who has either observed the patient clinically over an extended period or has administered a systematic, narrative-based interview, the Clinical Diagnostic Interview (Westen & Muderrisoglu, 2003) The SWAP-200 includes 200 personality descriptors derived from multiple sources, including DSM diagnostic criteria, relevant clinical and empirical literatures, research on normal personality traits, clinical experience, videotaped interviews, and input from hundreds of clinicians who piloted initial versions The items are written in jargon-free English close to the data (eg, Tends to be passive and unassertive ), so that they can be used by clinicians of any theoretical orientation Items that require inferences about internal processes are written in simple and straightforward language (eg.

, Tends to blame others for own failures or shortcomings; tends to believe his or her problems are caused by external factors or Tends to see own unacceptable feelings or impulses in other people instead of in him / herself ) Although the item set includes statements that reflect all of the Axis II criteria from DSM-IV (and many from prior editions of the DSM), it differs from Axis II in three primary ways First, it includes items that describe subtle, clinically important aspects of personality such as motives and affect regulation strategies (eg, defenses) that were not included in Axis II because of concerns that they could not be measured reliably Second, it addresses the range of personality pathology, from relatively healthy (including psychological strengths) to relatively severe.

To test whether changes in discomfort tolerance were mediated by activation of the endorphin system, half the participants in each condition received 10 mg of naloxone, a drug that inhibits the effect of opiates and, therefore, increases the sensation of pain The other half received 10 mg of a saline solution Results suggested that those who received cognitive training strengthened their self-efficacy to withstand and reduce pain The cognitive training and naloxone group, when compared to the group receiving cognitive training and saline, was less able to tolerate discomfort However, the cognitive group that received the naloxone was still able to increase discomfort tolerance to some degree This suggests a nonopioid component in cognitive pain control (Bandura et al, 1987) In conclusion, self-efficacy can be altered, but its effectiveness is accurately assessed only under task-specific conditions..

Third, to maximize content validity in item generation, we used a model of personality that specified domains of functioning (Westen, 1998) to ensure that we did not miss psychologically important processes not currently linked to any specific Axis II disorder We refined the item set over several years using standard psychometric procedures, soliciting feedback from hundreds of clinicians using the instrument, and eliminating or combining items with redundancy or limited variance A growing body of evidence supports the reliability and validity of the SWAP Research has shown high correlations between SWAP-200 descriptions made by treating clinicians and independent interviewers, between independent observers reviewing recorded interviews, and between clinician ratings and self-reported antisocial and borderline traits assessed by self-report (Bradley, Hilsenroth, & Westen, 2003; Shedler & Westen, 1998; Westen & Muderrisoglu, 2003).

Scores derived from the SWAP-200 and its adolescent version (the SWAP-200-A) correlate with a range of criterion measures, such as history of suicide attempts, arrests, psychiatric hospitalizations, social support, Global Assessment of Functioning, and family and developmental history variables (Dutra, Campbell, & Westen, 2004; Nakash-Eisikovits, Dierberger, & Westen, 2002; Westen & Shedler, 1999a; Westen et al, 2003)..

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