Illuminating a neglected clinical issue: societal costs of interpersonal dependency and dependent personality disorder

A new performance-based measure of personality functioning impairment: development and preliminary evaluation of reliability and validity

Personality functioning impairment is at the center of many dimensional models of personality. Available measures of personality functioning impairment are limited to self-report, clinician-/informant-rated, and interview methods. Although researchers have begun investigating established performance-based instruments' potential for assessing personality functioning impairment, administration and scoring of these instruments is complex and the latent variables they measure diverge from personality functioning impairment as described in the ICD-11 and the Alternative Model for Personality Disorders (AMPD) of the DSM. We address this absence by developing and psychometrically evaluating the Level of Personality Functioning Scale-Questionnaire-based Implicit Association Test (LPFS-qIAT). The LPFS-qIAT's psychometric properties were evaluated across four studies, producing initial evidence supporting the new instrument's reliability as well as its convergent, discriminant, and criterion-related validity. As the first performance-based measure of personality functioning impairment that aligns with the AMPD and, to a degree the ICD-11, that is easily administered, scored, and interpreted, the LPFS-qIAT shows potential to become a valuable tool in both research and clinical practice.

The association between adverse childhood events and cluster C personality disorders: A meta-analysis

INTRODUCTION

Studies suggest that adverse childhood events (ACEs) may contribute to the onset and development of cluster C personality disorders. However, the association between ACEs and these disorders remains unclear in terms of consistency across studies and effect magnitude, as well as generalizability within cluster C. The current meta-analysis aimed to examine the associations between ACEs and cluster C personality disorders based on the available literature.

METHODS

Systematic searches were conducted in PubMed, Scopus, Web of Science and PsychInfo. Forty-eight eligible studies were included in the analyses, and pooled effect sizes were estimated both at the level of cluster C and at the level of each specific disorder. Moderation and meta-regression analyses were also conducted.

RESULTS

ACEs were consistently associated with overall cluster C, as well as each of the specific disorders in this cluster. Sources of heterogeneity included type of instrument used to assess ACEs (questionnaires > interviews) and type of instrument used to assess the personality disorders (clinical interviews > questionnaires, as well as their combination with interview). The associations between ACEs and all cluster C personality disorders decreased with age.

CONCLUSIONS

ACEs are consistently associated with all cluster C personality disorders. Future work could approach the mechanisms underlying this association, preferably using longitudinal designs and considering the potential sources of effect variability identified in the present study.

Association between community environment and dependency among the elderly people from a service provision perspective

BACKGROUND

The incidence of dependency is high among the elderly people worldwide and increases with increasing life expectancy. The purpose of this study was to establish from the perspective of resource demand the association between community environmental resources and dependency among the elderly people.

METHODS

This study is a cross-sectional design based on community from 22 locations in China. A multistage sampling method was used to select the study objects. The questionnaires were used to collect the survey data by face-to-face interviews. A total of 950 individuals completed the survey, and 913 individuals were available for this analysis. Dependency and community environment were measured using the standard instruments. Logistic regression analysis was performed to identify the community environment factors associated with dependency. Cluster analysis was used and demonstrated that dependency was mainly associated with community primary preventive care service resources.

RESULTS

In the group aged under 70 years, the utilization of electronic health records and the need for health assessments, and rehabilitation equipment rentals were significantly associated with the levels of dependency scores: the OR was 2.81, 2.25 and 2.13 (P < 0.05), respectively. In the group aged 70 years and over, a short-term care home was strongly associated with levels of dependency: the OR was 4.01 (P = 0.002). The daycare and nursing service, transportation service, and regular lectures on health knowledge were associated with levels of dependency: the OR was 2.41, 1.86 and 1.93 (P < 0.05). In the group with low social support, an emergency call or monitoring system, transportation services, the need for health assessment, and regular lectures on health knowledge were significantly associated with levels of dependency: the OR was 2.42, 2.19, 1.89 and 1.98 (P < 0.05), respectively.

CONCLUSIONS

Community environment resources were significantly associated with dependency. These results suggest that the dependent on local environment resources may consider as the resource needs among elderly people.

Individual Differences in Judgment and Decision-Making: Novel Predictors of Counterproductive Work Behavior

The current paper proposed individual differences in judgment and decision-making (JDM)-namely, the skill associated with recognizing social norms, decision-making styles, and risk-benefit perceptions-as a novel set of predictors of counterproductive work behavior (CWB). We hypothesized that the skill associated with recognizing social norms, rational decision-making style, and perceived riskiness of unethical behavior would be related negatively to CWB, whereas the avoidant decision-making style, spontaneous decision-making style, and perceived benefits of unethical behavior would be related positively to CWB. Moreover, we hypothesized that JDM-focused individual differences would exhibit incremental validity above and beyond the traditional individual difference predictors of CWB (personality, trait affect, and cognitive ability). Results from three independent samples provided strong support for the hypotheses. The strongest predictor of CWB was individual differences in perceived benefits of unethical behavior (meta-analytic correlation across the three samples = .487). This result suggests a simple insight, yet one almost completely missing from the existing CWB literature: People who believe unethical behavior is likely to benefit them will tend to enact more CWB than those who do not. Additionally, across the three samples, the novel JDM-focused individual difference predictors performed well in comparison to the traditional individual difference predictors, suggesting their usefulness to research and practice. We therefore suggest several avenues for future research on JDM-focused individual differences as predictors of CWB. Additionally, vis-à-vis practical implications, we discuss the possibility of using JDM-focused individual differences in employee selection and organizational intervention contexts with the aim of reducing CWB.

Assessing the Impact of Relationship Profile Test Scores, Self-Identified Ethnic Group, and Gender on Adult Attachment Style

Research shows that the subscales of the Relationship Profile Test (RPT) are related to adult attachment. Gender differences have been implicated, but findings are inconsistent in terms of replication. A limited amount of research has been conducted on ethnic differences in the context of interpersonal dependency. This study aims to bridge the gap in the literature in terms of using the RPT to predict attachment styles and to assess gender and ethnic group differences in RPT scores. Four samples from various treatment settings were combined to yield a heterogeneous group of ethnically diverse men and women (N = 470) with a mean age of 31.96. No gender differences were observed; however, ethnic differences were noted, with the RPT scales predicting unique variance in secure and insecure attachment styles. This study evidences the incremental validity of the RPT scales when predicting adult attachment style with consideration of ethnic group differences, which can help inform the treatment and assessment process.

Association between dependency on community resources and social support among elderly people living in rural areas in China: a cross-sectional study

BACKGROUND

The prevalence of dependency personality disorder (DPD) is high among elderly people living in rural areas. This study aims to explore the association between dependency on community resources and social support among elderly individuals living in rural areas.

METHODS

A cross-sectional study was conducted in 26 locations in China. A total of 1160 participants aged ≥ 60 years were selected using a complex multistage sampling design. All data were obtained using questionnaires via face-to-face interviews. DPD was measured using the Minnesota Multiphasic Personality Inventory-II in the standardized Chinese version. Self-efficacy was assessed using the Chinese version of the General Self-Efficacy Scale. Social support was measured using the Chinese version of the questionnaires of the Older American Resources and Services scale. Community services and resources comprised 44 items. The association between DPD and levels of social support and self-efficacy was evaluated using a logistic regression model. The association between social support and self-efficacy was assessed using analysis of covariance.

RESULTS

Univariate analysis results showed that elderly people living in rural areas had higher DPD scores and lower levels of self-efficacy compared with those living in urban areas (P < 0.001). Logistic regression analysis showed that DPD was positively associated with the received frequencies of community health service, contracted family doctor services, and regular lectures on health knowledge among the elderly people with odd ratios of 1.58 (P < 0.001), 2.03 (P = 0.013), and 2.67 (P = 0.005), respectively. Logistic regression analysis showed significant interaction between social support and self-efficacy effect on DPD was found in the additive model (P < 0.001).

CONCLUSION

DPD was associated mainly with the community resources among elderly people living in rural areas. Social support and self-efficacy were commonly associated with DPD through a synergistic effect. These results suggest that DPD among elderly people may be reduced through effective social support to directly and indirectly promote the elderly's use of community resources and improve their self-efficacy.

Socioeconomic Status Association With Dependency From Objective and Subjective Assessments: A Cross-Sectional Study

BACKGROUND

The effect of socioeconomic status (SES) on dependency is still complex and not fully clear. The purposes of this study are to assess the association between SES and dependency personality disorder (DPD) using both objective and subjective assessments.

METHODS

A cross-sectional study was conducted in 27 locations in China among 1,276 general residents aged 60 years and above through a complex multistage sampling design. Data were collected using a questionnaire by well-trained investigators through face-to-face interviews. The DPD was assessed using a standardized Chinese version of the Minnesota Multiphasic Personality Inventory-II scale. Objective SES was assessed by the combination of education levels, individual income, preretirement occupation, and medical insurance. Subjective SES was measured using the MacArthur Scale. The logistic regression analysis was used to evaluate the association between objective SES and DPD. Analysis of covariance was conducted to compare the mean of DPD scores in different levels of SES.

RESULTS

The results of the chi-squared test showed that the levels of objective SES were associated with DPD, depression, social resources, and region. The logistic regression analysis showed a significant negative association between the levels of objective SES and DPD. The odds ratio was 1.84 (95% confidence interval, 1.07-3.18) after adjusting for important confounding factors. The analysis of covariance showed differences in the mean of DPD scores among different groups defined by different levels of SES.

CONCLUSION

The levels of SES were negatively associated with DPD, and subjective SES had a stronger association with DPD than objective SES. The effect of subjective SES on DPD is possibly associated with the perception of position in the social hierarchy.

Dependent Personality in Depressed Older Adults: A Case Report and Systematic Review

Personality pathology in older adults is largely understudied. Here, we present a case report of an older adult who presented to an inpatient geriatric psychiatry unit with dependent personality traits in the context of chronic major depressive disorder, followed by a systematic review of the literature to identify research regarding the diagnosis and prevalence of dependent personality in depressed older adults. We identified 11 studies relevant to this topic. Synthesis of these data revealed that dependent personality is generally more common in depressed older adults compared to other personality disorders. However, studies were limited by small sample sizes and the use of assessments not validated for use in older adults. Therefore, it is difficult to draw conclusions from the available data. Potential implications for patient outcomes and health care services utilization are discussed. Our review highlights the need for larger scale research and personality assessments which are sensitive to age-related factors in order to draw evidence-based conclusions.

Italian Version of the Relationship Profile Test (RPT-I): Temporal Stability, Construct Validity, and Cross-Cultural Comparison

This study presents the adaptation to the Italian context of the Relationship Profile Test (RPT; Bornstein & Languirand), a self-report measure of Destructive Overdependence (DO), Dysfunctional Detachment (DD), and Healthy Dependency (HD). The RPT was administered to a community sample of 661 nonclinical Italian adults together with the Attachment Style Questionnaire, the Relational-Interdependent Self-Construal Scale, the Rosenberg Self-Esteem Scale, the Self-Compassion Scale, the Positive Affect-Negative Affect Scale, and the Toronto Alexithymia Scale. A randomly selected subset of participants (n = 67) completed the RPT again approximately 5 months after the first administration. The factor structure of the RPT obtained in the main sample was compared with that obtained in a sample of 603 adult participants from the US and was found to be similar. Internal consistency for DO, DD, and HD scores in the Italian sample fell between the acceptable to good range, and test-retest reliability coefficients were all above .70. The three scales yielded the expected pattern of correlations with theoretically related constructs, documenting good criterion validity. Findings are discussed in light of the literature on the RPT as a measure of interpersonal dependency and detachment. Suggestions for future research are offered.

The role of social support in the association between dependency and important risk factors among the elderly

BACKGROUND

This study aimed to assess the association between social resources and dependency, and explored the effect of social support in modifying important risk factors for dependency among the elderly.

METHODS

This was a population-based cross-sectional study. A total of 950 participants aged ≥60 years were selected using a complex multistage sampling design from 22 locations in China. All data were collected using questionnaires by face-to-face interviews. Dependency was assessed using the Minnesota Multiphasic Personality Inventory-II, and social resource status with the Chinese version of the Older American Resources and Services (OARS) questionnaire. Logistic regression analysis was used to evaluate the association between dependency and social resources. Analysis of covariance was performed to evaluate the effect of social support on modifications of important risk factors for dependency.

RESULTS

A total of 913 participants were included in the analysis, and 10.3% of the males and 14.4% of the females were identified as in dependency. The results of logistic regression analysis showed a significant negative association between the levels of social resources and dependency. The odds ratio was 0.78 (95% confidence interval, 0.73-0.84) after adjusting for important confounding factors. The results of analysis of covariance showed differences in the mean dependency scores between different groups defined by chronic disease status and social support level.

CONCLUSIONS

Levels of social resources were negatively associated with dependency. Our results suggest that social support has both a direct effect on dependency and an indirect effect through modifying chronic disease status and individual income.

Important Dependency-Associated Community Resources among Elderly Individuals with a Low Level of Social Support in China

Background: The prevalence of dependency personality disorder is high among elderly individuals with a low level of social support. The objective of this study was to explore the dependency associated with important community resources among elderly individuals with a low level of social support from the perspective of resource demand. Methods: The population-based cross-sectional study was conducted in 22 locations in China. A total of 950 participants aged ≥60 years were selected using a complex multistage sampling design. All the data were collected using questionnaires via face-to-face interviews. The dependency was assessed using the standardized Chinese version of the Minnesota Multiphasic Personality Inventory-II. Community resources were assessed using 43 items. Logistic regression analysis was used to evaluate the association between dependency and important community resources. Results: Bivariate analysis showed that the level of social support was negatively associated with levels of income (p < 0.001) and education (p = 0.008) and was positively associated with social communication and interactions (p < 0.001). The logistic regression analysis showed that the emergency call or survival monitoring system (ECSMS) was the most important community resource that was significantly associated with the levels of dependency; the odds ratio was 2.64 (95% CI, 1.07–3.91; p = 0.031) among elderly individuals with a low level of social support. Conclusions: The levels of dependency were most significantly associated with the ECSMS among elderly individuals with a low level of social support. Our results suggest that improving the ECSMS can be the main problem in the development of community resources.

Subjective life experiences of family caregivers of dependent older adults

This study aimed to understand the subjective meanings attributed to home care by family caregivers of dependent older adults through a multicenter qualitative investigation that gathered 84 in-depth interviews with family caregivers from eight Brazilian locations. The hermeneutic-dialectic, theoretical, methodological framework was employed. The following categories emerged from the analysis: 1. Movements inhibiting emotions and feelings; 2. Presence of processes of symbiosis and emotional dependence in the older adult-relative relationship; 3. Contentment in caring for the dependent older adult; and 4. Giving up current and future life projects. The results reveal life experiences marked by symbiotic processes, emotional dependence, and psychic stress. Dependence causes suffering and feelings of despair, powerlessness, impatience, but also solidarity and empathy. Withdrawal from the job market, social depreciation of family caregiver's activity, social isolation, neglected self-care, and family conflicts impact caregivers' subjectivity. The elaboration of public policies must consider the social-affective life experiences of family caregivers of dependent older adults in order to include the care of those providing care.

Dimensional clinical personality inventory-2: investigating key factors on the assessment of dependent personality disorder

Dimensional literature reinforces the relevance of specific Dependent personality disorder (DPD) traits, as submissiveness, insecurity and avoidance of abandonment. In this paper we measured these traits through the Dimensional Clinical Personality Inventory-2 (IDCP-2). This study aims to verify the capacity of IDCP-2 factors to discriminate and predict DPD related symptoms. From a dataset with 4,503, a total of 305 people was divided in three groups: the community group (n = 200), the non-DPD group (N = 84), and the DPD group (n = 21). We administered six factors from IDCP-2, Insecurity, Abandonment Avoidance, Self-devaluation, Submissiveness, Masochism, and Self-driven Hopelessness. Groups comparison were significant, showing high effects in mostly cases. Multiple regression analysis showed the best predictors of the groups, i.e. Abandonment Avoidance and Self-driven Hopelessness. The findings of this study demonstrate that IDCP-2 covers the core traits of DPD, therefore, being a valid and applicable measure to discriminate DPD, which is particularly relevant in clinical settings. Although our findings suggested two factors as the most relevant measures to discriminant DPD patients from non-DPD/community samples, we did not suggest the restrict use of the Abandonment Avoidance and Self-driven Hopelessness factors for DPD screening. Limitations of the study were discussed.

Coverage of the DSM-IV-TR/DSM-5 Section II Personality Disorders With the DSM-5 Dimensional Trait Model

Section III of DSM-5, for emerging measures and models, includes a five-domain, 25-trait model, assessed by the Personality Inventory for DSM-5. A primary concern with respect to the trait model is its coverage of the DSM-IV-TR personality disorder syndromes (all of which were retained in DSM-5). The current study considered not only total scale scores of three independent measures of DSM-IV-TR personality disorders but also the coverage of each diagnostic criterion included within six personality disorders: antisocial, borderline, avoidant, dependent, narcissistic, and obsessive-compulsive. Participants were 425 community adults, all of whom had received mental health treatment (36% currently; 75% within the past year). Results provided support for the coverage of the diagnostic criteria for the antisocial, borderline, avoidant, dependent, and narcissistic personality disorders. Coverage could perhaps be improved for a few of the criteria for obsessive-compulsive personality disorder.

Establishing a clinically relevant cutoff to the Dependency Scale from the dimensional clinical personality inventory

The Clinical Dimensional Personality Inventory (IDCP) is a 163-item self-report tool developed for the assessment of 12 dimensions of personality pathology. One of the scales comprising the instrument-the Dependency scale-is intended to provide psychometric information on traits closely related to the Dependent Personality Disorder (DPD). In the present study, we used both Item Response Theory modeling and Receiver Operating Characteristic curve analysis to establishing a clinically meaningful cutoff for the IDCP Dependency Scale. Participants were 2.481 adults, comprised by outpatients diagnosed with DPD, outpatients diagnosed with other PDs, and adults from the general population. The Wright's item map graphing technique revealed that outpatients were located at the very high levels in the latent scale continuum of the Dependency Scale, with a very large effect size for the mean difference between patients and non-patients. The ROC curve analysis supported a cutoff at 2.3 points in the Dependency Scale, which yielded 0.86 of sensitivity and 0.79 of specificity. Findings from the present investigation suggest the IDCP Dependency Scale is useful as a screening tool of the core features of the DPD. We address potential clinical applications for the instrument, and discuss limitations from the present study.

Dimensions of dependence and their influence on the outcome of cognitive behaviour therapy for health anxiety: randomized controlled trial

BACKGROUND

The personality trait of dependence is common in health-seeking behaviour. We therefore examined its impact in a large randomized controlled trial of psychological treatment for health anxiety.

AIMS

To test whether dependent personality traits were positive or negative in determining the outcome of an adapted form of cognitive behaviour therapy for health anxiety (CBT-HA) over the course of 5 years and whether dependent personality dysfunction could be viewed dimensionally in a similar way to the new ICD-11 diagnostic system for general personality disorder.

METHOD

Dependent personality dysfunction was assessed using a self-rated questionnaire, the Dependent Personality Questionnaire, at baseline in a randomized controlled trial of 444 patients from medical clinics with pathological health anxiety treated with a modified form of CBT-HA or standard treatment in the medical clinics, with assessment on five occasions over 5 years. Dependent personality dysfunction was assessed using four severity groups.

RESULTS

Patients with mild and moderate dependent personality disorder treated with CBT-HA showed the greatest reduction in health anxiety compared with standard care, and those with no dependent dysfunction showed the least benefit. Patients with higher dependent traits received significantly more treatment sessions (8.6) than those with low trait levels (5.4) (p < 0.01).

CONCLUSION

The results suggest that patients treated with cognitive behaviour therapy for health anxiety respond better if they have moderate dependent personality. The reasons for this may be related to better adherence to psychological treatment and greater negative effects of frequent reassurance and excessive consultation in those treated in standard care. Copyright © 2016 John Wiley & Sons, Ltd.

The psychological impact of dependency in adults with chronic fatigue syndrome/myalgic encephalomyelitis: A qualitative exploration

Chronic fatigue syndrome/myalgic encephalomyelitis can limit functional capacity, producing various degrees of disability and psychological distress. Semi-structured interviews explored the experiences of adults with chronic fatigue syndrome/myalgic encephalomyelitis being physically dependent on other people for help in daily life, and whether physical dependency affects their psychological well-being. Thematic analysis generated six themes: loss of independence and self-identity, an invisible illness, anxieties of today and the future, catch-22, internalised anger, and acceptance of the condition. The findings provide insight into the psychological impact of dependency. Implications for intervention include better education relating to chronic fatigue syndrome/myalgic encephalomyelitis for family members, carers, and friends; ways to communicate their needs to others who may not understand chronic fatigue syndrome/myalgic encephalomyelitis; and awareness that acceptance of the condition could improve psychological well-being.

Beyond passivity: Dependency as a risk factor for intimate partner violence

Interpersonal dependency in male perpetrators of intimate partner violence (IPV) is an understudied phenomenon but one that has noteworthy clinical implications. The present investigation used meta-analytic techniques to quantify the dependency-IPV link in all extant studies examining this relationship (n of studies = 17). Studies were gathered via an extensive literature search using relevant dependency/IPV search terms in the PsychInfo, Medline and Google Scholar databases. Results revealed a small but statistically significant relationship between dependency and perpetration of IPV in men (r = 0.150, Combined Z = 4.25, p < 0.0001), with the magnitude of the dependency-IPV link becoming stronger (r = 0.365, Combined Z = 6.00, p < 0.0001) when studies using measures of dependent personality disorder symptoms were omitted. Other moderators of the dependency-IPV effect size included IPV measure, type of sample and perpetrator age. These findings illuminate the underlying dynamics and interpersonal processes involved in some instances of IPV and may aid in understanding how to identify and treat male perpetrators of domestic violence.

Construct Validity of the Relationship Profile Test: Links With Measures of Psychopathology and Adult Attachment

This study assessed the construct validity of the Relationship Profile Test (RPT; Bornstein & Languirand, 2003 ) with a substance abuse sample. One hundred-eight substance abuse patients completed the RPT, Experiences in Close Relationships Scale-Short Form (Wei, Russell, Mallinckrodt, & Vogel, 2007 ), Personality Assessment Inventory (Morey, 1991 ), and Symptom Checklist-90-Revised (Derogatis, 1983 ). Results suggest that the RPT has good construct validity when compared against theoretically related broadband measures of personality, psychopathology, and adult attachment. Overall, health dependency was negatively related to measures of psychopathology and insecure attachment, and overdependence was positively related to measures of psychopathology and attachment anxiety. Many of the predictions regarding RPT detachment and the criterion measures were not supported. Implications of these findings are discussed.

Mindfulness Therapy for Maladaptive Interpersonal Dependency: A Preliminary Randomized Controlled Trial

Existing treatments for maladaptive interpersonal dependency and dependent personality disorder do not meet basic scientific standards for effectiveness. The present investigation tested the efficacy of a mindfulness-based approach: mindfulness therapy for maladaptive interpersonal dependency (MT-MID). Forty-eight participants who reported consistently high levels of maladaptive dependency (i.e., scored higher than 1 standard deviation above the mean on the Interpersonal Dependency Inventory at two separate assessments) were randomized to either 5 sessions of MT-MID or a minimal contact control. Five self-reported outcomes (mindfulness, maladaptive interpersonal dependency, helplessness, fears of negative evaluation, and excessive reassurance seeking) were assessed at pretreatment, posttreatment, and a 4-week follow-up. Intent-to-treat analyses indicated that MT-MID yielded greater improvements than the control on all 5 outcomes at posttreatment (median d=1.61) and follow-up (median d=1.51). Participants assigned to MT-MID were more likely than control participants to meet criteria for clinically significant change at posttreatment (56.5% vs. 0%) and follow-up (42.9% vs. 0%). There was also evidence that increases in mindfulness mediated the dependency-related improvements. These results provide preliminary support for the efficacy of a mindfulness-based approach for treating the symptoms of maladaptive dependency.

Assessment of dependency by the FFDI: Comparisons to the PID-5 and maladaptive agreeableness

The present study explores the validity of the Five Factor Dependency Inventory (FFDI), a measure of dependent personality traits from the perspective of the five factor model, examined across three separate samples and two studies. The first study examined the FFDI with respect to the traits assigned to assess dependent personality disorder (DPD) by the DSM-5 work group, two measures of DSM-IV-TR DPD and three measures of dependent traits, sampling 184 Mechanical Turk participants and 83 students (the latter oversampled for DPD features). Based on responses from an additional 137 students, the second study investigated the role of maladaptive agreeableness in dependency by examining the FFDI in relation to the interpersonal circumplex using three alternative measures. Discriminant validity was provided with respect to DSM-5 traits and the interpersonal circumplex. Incremental validity was provided with respect to the ability of the FFDI to account for variance within DPD measures beyond the variance explained by DSM-5 traits. Implications for the assessment of dependency and the proposed DSM-5 dimensional trait model are discussed.

Disambiguating Dependency and Attachment Among Conjugally Bereaved Adults

This study aims to investigate the effects of dependency and attachment in adjusting to the loss of a loved one by directly comparing the relative contribution of each to bereavement outcomes among midlife adults. Comparisons among attachment and dependency are made using models that control for attachment among three groups of bereaved adults (N=102): prolonged grievers (n=25), resolved grievers (n=41), and a married comparison group (n=36). Prolonged grievers displayed higher marginal means of dysfunctional detachment dependency and lower marginal means of healthy dependency compared to resolved grievers and married adults, even when controlling for attachment style. Findings suggest that attachment and dependency predict unique domains of grief outcome.