Translation and cultural adaptation of the DSM-5 Personality Inventory – Brief Form (PID-5-BF)

Abstract Introduction The Personality Inventory for the DSM-5 – Brief Form (PID-5-BF) – is an instrument for assessment of the five pathological personality traits from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) alternative model of personality disorders. Objectives To determine the psychometric properties of the version of the PID-5-BF translated and adapted to Brazilian Portuguese. Methods The process of translating and cross-culturally adapting the text was carried out by independent translators and the resulting version was administered to 176 patients in two hospitals in Rio Grande do Sul. The internal structure was tested by means of confirmatory factor analysis. Evidence of reliability was tested by examining the internal consistency of the scales and their convergent and concurrent validity with other methods of psychopathology. Results The five factors were replicated in the present sample with adequate indicators of fit of the data to the model. Appropriate reliability coefficients for the scales and evidence of validity were observed, indicating the clinical usefulness of the PID-5-BF in the Brazilian context. Conclusion The psychometric properties of PID-5-BF proved satisfactory in an initial sample of Brazilians.


Introduction
The fifth edition of the Diagnostic and Statistical  [3][4][5] This new diagnostic model, with its criterion B, brought in an empirical model based on pathological personality traits. The results of initial studies indicated five broad factors that describe an individual's main maladaptive behaviors, beliefs, thoughts and feelings. 3 These factors are negative affectivity, detachment, antagonism, disinhibition, and psychoticism, and they can be assessed using the Personality Inventory for the . 3 This instrument is currently available in five formats: 1) the complete self-report version (PID-5), composed of 220 items 3  seen as a useful tool to aid decision-making in clinical settings. 4,5 As a measure for tracking personality pathology, the PID-5-BF has a number of potentially attractive characteristics, such as rapid verification of pathological personality traits, demanding little time to answer the questionnaire, and little time for the clinician to present results. Studies have shown that the PID-5-BF has adequate psychometric properties. 2,5,[11][12][13] In fact, the literature indicates a strong correspondence between scores on the complete version of the PID-5 and scores on the brief form (PID-5-BF). 5,11,12 All of its factors have presented satisfactory indicators of reliability according to Cronbach's alpha and indicators of validity, showing a consistent nomological network between the PID-5-BF factor scores and scores from measures of psychiatric symptoms, 2,5,11 the five-factor personality model, 2,5,14 and other personality pathology models. [11][12][13] Considering the clinical and scientific utility of the

Method
Translation and cross-cultural adaptation were conducted in six steps, which are recommended in the main guidelines for cross-cultural adaptation of instruments. Figure 1 contains a flowchart illustrating the steps taken to translate and cross-culturally adapt the PID-5-BF for the Brazilian language and culture. Portuguese (6).

Results and discussion
Very few cultural adaptations were necessary. Three items were adapted in order to replace unfamiliar words. For example, the English expression "Zone Out" presented in the 23rd item was translated as "I go off air," which is a Brazilian expression that imparts the same meaning as the English expression and is familiar to Brazilians. In addition to employing procedures to maintain semantic equivalence between the original and translated versions of the instruments, operational equivalence was also prioritized. Therefore, the operational characteristics of the original instrument, such as the same number of questions and the same four response options, were maintained.
Based on the procedures used and the results found, we believe that the two versions of the PID-5-BF (i.e., the original and the Brazilian) are semantically and operationally equivalent. It is understood, therefore, that the instrument can be used in Brazil and that possible differences between the results observed in the two cultures (the United States and Brazil) will not be due to semantic differences between the instrument versions, but rather due to cultural differences in expression of pathological personality traits.
Finally, it is worth mentioning that when this study began, the main authors of the current study were not aware that other versions of the PID-5 were under development. 16,17 The authors compared the versions of the instrument and found that they were very similar.  for enrollment, and after each patient had been seen by the outpatient service, they were then taken to a private consultation room and the instruments were administered, following the same order of administration as at the HPS.

Data analysis
Initially, we explored the sociodemographic variables to describe participants' characteristics. Next for WRMR. [19][20][21][22][23] Reliability was examined in terms of internal consistency coefficients. Cronbach's alpha and McDonald's omega were calculated. 24 Models were constructed in two steps, by forced entry.
In the first step, the variables sex, age, and years of study were added and then the PID-5-BF factor scores were added in the second step. The models' fit indexes were determined and residuals were analyzed.

Ethical aspects
All participants were given the necessary explanations regarding the procedures involved in the research. The reliability of the scales was estimated using several strategies (see results in Table 2). The results were adequate for all scales except antagonism.
All scales had adequate results for the CR and AVE coefficients.
The validity of the PID-5-BF was analyzed by correlating its scores with the participants' degree of suicide risk and with the total number of diagnoses of mental disorders according to the MINI-Plus. 18 Table 3   Another investigation of validity compared the scores of the PID-5-BF between participants who either did or did not fulfill the criteria for a mental disorder according to the MINI-Plus. Table 4 presents the results obtained.
For this analysis, disorder categories were grouped as follows: mood disorders included depressive disorder, dysthymia, and bipolar disorder; anxiety disorders included social phobia, agoraphobia, panic disorders, and generalized anxiety disorder; and eating disorders included bulimia and anorexia nervosa. Obsessive-

Domains of the PID-5-BF Suicide risk, rho (p) Number of diagnoses, rho (p)
Negative affectivity 0.367 (< 0.001) 0.519 (< 0.001)    Table 5). The obsessive-compulsive disorder and eating disorders categories were not analyzed because fewer than 10 cases screened positive for them, which meant that analysis was unfeasible.

Discussion
The present study aimed to present the procedures used for the cross-cultural adaptation of the PID-5-BF for the Brazilian culture and to investigate its psychometric properties in a sample of patients from two public hospitals in the southern region of Brazil.
In general, the results indicated that the Brazilian version of the PID-5-BF has semantic and operational equivalence with the original version, guaranteeing the It should be noted that our initial hypothesis was that the PID-5 variable psychoticism would be within the psychotic syndrome framework of the MINI-Plus.
Psychoticism was present in the framework of anxiety disorders. What should be observed is that people with anxiety disorders have difficulty with reality, behavior and perception.
Another expectation of the present study was In the analyses of the MINI-Plus against the PID-5, the n(Positive) was low compared with n(Negative). Further investigation is required to obtain more robust results.
It is therefore not recommended that the results found here be generalized. Before this, new studies should be made using different samples and larger numbers of participants.

Conclusion
The objective of the present study was to investigate the initial psychometric properties of the PID-5-BF in a