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.

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 complex role of personality in cancer treatment: impact of dependency-detachment on health status, distress, and physician-patient relationship

Personality traits have been associated with positive and negative adjustment to a cancer diagnosis. No studies have assessed trait dependency and detachment and their relationship to health, distress, and the doctor-patient relationship in patients undergoing radiation treatment for cancer. Fifty adults (32 women; mean [SD], 60.32 [12.74] years) undergoing radiation treatment for a variety of cancers completed measures of dependency and detachment, doctor-patient relationship, physical health, somatization, anxiety, and depression. Overdependence scores were positively and significantly correlated with patients' anxiety and negatively and significantly correlated with the physician-patient relationship. Detachment scores were positively and significantly correlated with pain, somatization, depression, and anxiety and marginally associated with lower health-related quality of life. These preliminary findings support the construct validity and clinical utility of trait dependency and detachment testing with oncology patients and suggest that detachment is associated with poorer quality of life and higher psychological distress, whereas dependency is associated with poorer doctor-patient relationships after a cancer diagnosis.

Relationship between alexithymia and dependent personality disorder: a dimensional analysis

The present study had two aims and used two different samples. The first aim was to determine if alexithymia and dependent personality disorder (DPD) are distinct or overlapping constructs. The second aim was to determine the specificity and the stability of the relationship between alexithymia and DPD. The first study used exploratory principal components analysis (PCA) in a sample of 477 non-clinical subjects who completed three questionnaires measuring alexithymia (Twenty item Toronto Alexithymia Scale, i.e. TAS-20), dependent personality disorder (Dependent Personality Questionnaire, i.e. DPQ) and depression (Beck Depression Inventory-II, i.e. BDI-II). The second study used a sample of 305 subjects consecutively admitted to an outpatient department of legal medicine. The subjects completed (at admission and 3 months later) the Structured Clinical Interview for DSM-IV, screen questionnaire (SCID-II-SQ), the TAS-20 and the BDI. Multiple regressions were done. For the first study, the PCA yielded a four-factor solution with no overlap of the significant factor loadings for the items from each scale and with the factors corresponding to their respective construct. For the second study, multiple regressions showed that only avoidant personality disorder was an independent predictor of the TAS-20 scores. Alexithymia is a construct that is distinct and separate from DPD and depression. Alexithymia is not a stable feature of DPD while it is a core feature of avoidant personality disorder.

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

OBJECTIVES

To determine the degree to which patients with high levels of trait dependency or dependent personality disorder (DPD) engage in behaviors that harm themselves and others (e.g., domestic violence, child abuse).

METHOD

Six domains of literature were reviewed: (a) dependency as a risk factor for physical illness; (b) health care utilization and expenditures; (c) global and domain-specific functional impairment; (d) violence toward others; (e) victimization by others; and (f) self-harm.

RESULTS

High levels of trait dependency and DPD are associated with elevated risk for physical illness, partner and child abuse, and suicidality, as well as with high levels of functional impairment and increased health care expenditure.

CONCLUSIONS

Contrary to clinical lore, trait dependency and DPD are associated with behaviors that lead to myriad negative consequences for the dependent person, those close to them, and society as a whole. These patterns have noteworthy implications for assessment and treatment of dependent patients and suggest that DPD should be included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition.

From Dysfunction to Adaptation: An Interactionist Model of Dependency

Contrary to clinical lore, a dependent personality style is associated with active as well as passive behavior and may be adaptive in certain contexts (e.g., in fostering compliance with medical and psychotherapeutic treatment regimens). The cognitive/interactionist model conceptualizes dependency-related responding in terms of four components: (a) motivational (a marked need for guidance, support, and approval from others); (b) cognitive (a perception of oneself as powerless and ineffectual); (c) affective (a tendency to become anxious when required to function autonomously); and (d) behavioral (use of diverse self-presentation strategies to strengthen ties to potential caregivers). Clinicians' understanding of the etiology and dynamics of dependency has improved substantially in recent years; current challenges include delineating useful subtypes of dependency, developing valid symptom criteria for Dependent Personality Disorder in DSM-5 and beyond, and working effectively with dependent patients in the age of managed care.

Physical health correlates of pathological and healthy dependency in urban women

This study assessed the relationship between dependency and indicators of health/illness, healthcare costs, and utilization. Dependency ratings were obtained using the Relationship Profile Test (Bornstein and Languirand, 2003), a questionnaire that assesses healthy and pathological dependency: destructive overdependence (DO), dysfunctional detachment (DD), and healthy dependency (HD). The sample consisted of primarily low-income, African-American, and female primary care patients (N = 110). DO and DD were significantly associated with indices of increased illness, with DO evidencing slightly larger effect sizes than DD. HD was significantly (negatively) associated with 1 health/illness variable. DD and DO were associated with higher total outpatient costs with DD also being associated with average costs per visit. DO and HD were associated with utilization (increased hospital days and fewer emergency room visits, respectively). Further research is recommended to inform researchers and clinicians about the dependency-illness relationship and to develop interventions that maximize HD and minimize pathological dependency.

The adaptive and maladaptive faces of dependency in later life: links to physical and psychological health outcomes

OBJECTIVES

Negotiating the balance between reliance on others and desires for autonomy is a fundamental task of successful aging. The purpose of the present study was to replicate and extend a three-factor model of interpersonal dependency in a sample of older adults, and to examine the physical and psychological health correlates of this multifaceted construct.

METHODS

Data come from the third wave of a population-based study of older Americans (n = 166; mean age 80 years). We conducted an exploratory factor analysis of selected dependency items from two scales, and then conducted logistic and hierarchical linear regressions to analyze the association of dependency factors with self-reported health, use of hypertension medication, depressed affect and positive affect.

RESULTS

We found three factors closely paralleling those of Bornstein and Languirand's (Psychological Bulletin, 112(1), 3-23, 2004) measure: destructive overdependence, healthy dependency and dysfunctional detachment, as well as a fourth factor we labeled 'healthy independence'. Healthy dependency was associated with better self-reported health. Dysfunctional detachment was related to a greater likelihood and healthy independence a lesser likelihood of taking hypertension medication. Whereas both healthy independence and healthy dependency were positively related to positive affect and negatively related to depressed affect, destructive overdependence was positively related to depressed affect.

CONCLUSION

Understanding the complex nature of interpersonal dependency and autonomy in old age, as well as their implications for health and wellbeing, may enable practitioners to assist older adults in negotiating the task of balancing these needs.

Interpersonal dependency in older adults and the risks of developing mood and mobility problems when receiving care at home

Despite a broad interest in various types of dependency as they relate to older people (structured dependency, learned dependency, learned helplessness, and interdependency), research of dependency in older people has not included an individual difference measure of interpersonal dependency. Studies that have examined the correlates of interpersonal dependency in general populations have found links with mental health conditions such as depression and anxiety and also with physical illness. If these findings could generalise to older populations then there would be important intervention and financial implications for providers of health services to older adults. This research examined the correlates of interpersonal dependency in older adults using a new measure of interpersonal dependency-the Interpersonal Dependency Scale for Older Adults (IDS-OA). One hundred and five new clients aged 65-90 years recruited through a private home care agency responded to a postal survey requesting their completion of a questionnaire package. Interpersonal dependency was found to correlate significantly with both depression and mobility. In addition, a hierarchical regression analysis found that both higher interpersonal dependency and depression were significant positive predictors of poor mobility in older adults.

Rorschach assessment of changes following psychotherapy: a meta-analytic review

I examined Rorschach assessment of personality changes following psychotherapy. I conducted a comprehensive literature search to find all studies using the Rorschach method at least twice for the same participant in connection with psychotherapy. I conducted meta-analyses for 38 samples, and I performed regression analyses to identify moderating factors. Across all Rorschach scores, the total weighted sample effect size was r = .26, and nearly half the variables obtained effect sizes higher than .30. Several moderating factors were found. Most important, effect sizes increased with longer and more intensive therapy. More concern for interscorer reliability was associated with larger effect sizes, whereas a higher degree of scorer blinding was associated with smaller effect size magnitudes. Predicted levels of change based on the regression models indicated substantial increases in effect size with longer therapies. The data indicate that many elements in the Rorschach are valid indicators of change despite the poor reputation the method has acquired within psychotherapy research.

Persönlichkeit, chronischer Stress und körperliche Gesundheit

Zusammenfassung. Die prospektive Studie dient der Überprüfung eines systemischen Anforderungs-Ressourcen-Modells der körperlichen Gesundheit. Untersucht wurden 276 nach Zufall ausgewählte Erwachsene im Alter von 17 bis 70 Jahren. Sie beantworteten das Trierer Integrierte Persönlichkeitsinventar (TIPI) und zwei Jahre später das Trierer Inventar zum chronischen Stress (TICS), den Fragebogen zur habituellen körperlichen Gesundheit (FHKG) sowie einen Fragebogen zum aktuellen Gesundheitszustand (FGZ). Die theoretischen Annahmen wurden als Strukturgleichungsmodell formuliert und mit dem Programm LISREL 8.5 überprüft. Modellkonform zeigte sich, dass sich beträchtliche Varianzanteile in zwei Facetten der körperlichen Gesundheit (“habituelle körperliche Gesundheit“ und “akute Beschwerden und Erkrankungen“) mit Hilfe von personalen Ressourcen (bzw. Ressourcendefiziten) und chronischem Stress (vor allem “Mangel an Bedürfnisbefriedigung“) aufklären lassen. Die Ergebnisse werden unter anderem bezüglich ihrer Relevanz für die Gesundheitsförderung und Prävention diskutiert.

Links between psychological sense of control and disturbed eating behavior in women with diabetes mellitus. Implications for predictors of metabolic control

PURPOSE

Eating disturbances and aspects of psychological control are both repeatedly cited as significant correlates of metabolic control in diabetes mellitus (DM), yet such findings are typically discussed in separate literatures and have been criticized for overreliance on outdated constructs of psychological control when more complex means of analysis are available.

METHODS

Utilizing a multidimensional control inventory, this study investigates the relationship between eating disturbance and psychological sense of control, and assesses the utility of these two constructs in predicting metabolic control in 96 women recruited from a specialist diabetes clinic.

RESULTS

Despite significantly overlapping relationships between these two predictor variables and metabolic control, it is control specific to the domain of interpersonal relationships, along with eating disturbance in the form of bulimia/food preoccupation, that independently predicts level of metabolic control.

CONCLUSIONS

These findings have implications for the current form and content of psychological interventions in the management of DM.

The hard science of Rorschach research: what do we know and where do we go?

As the final article in the Special Series on "The Utility of the Rorschach for Clinical Assessment," the authors provide an overview of this instrument's current status. They begin with a thorough review of global and focused meta-analyses, including an expanded analysis of K. C. H. Parker, R. K. Hanson, and J. Hunsley's (1988) data set, and conclude that Rorschach, Minnesota Multiphasic Personality Inventory, and IQ scales each produce roughly similar effect size magnitudes, although all tests have greater validity for some purposes than for others. Because this evidentiary foundation justifies addressing other issues, the authors build on contributions to the Special Series to identify 11 salient theoretical and empirical gaps in the Rorschach knowledge base and make recommendations for addressing these challenges to further the evolution of the Rorschach and document its strengths and inherent limitations.

Metabolic control and psychological sense of control in women with diabetes mellitus. Alternative considerations of the relationship

PURPOSE

Identifying psychological strategies to buffer the adverse outcomes in people with diabetes mellitus (DM) remains a priority for many health professionals. While 'locus of control' (LOC) has been repeatedly investigated to this end, research findings are contradictory. The development of more complex appraisals of psychological control, and the utilization of control inventories deriving from such analyses, presents a way forward from such contradictions.

METHODS

Employing such a measure, this study examines the relationship between metabolic control and psychological sense of control in 96 women with DM.

RESULTS

Optimal metabolic control is significantly associated with overall sense of control, while poor metabolic control was significantly associated with experiences of loss of psychological control and feelings of inadequacy. Furthermore, poor metabolic control was significantly associated with reduced control in the specific domains of interpersonal relationships and bodily functions.

CONCLUSIONS

Multidimensional control inventories enable a more complex appraisal of the relationship between metabolic control and psychological control, and in doing so, provide a way forward from problems arising from reliance on LOC constructs. Interventions for DM management relying on aspects of psychological control need to target domains beyond traditional issues of self and bodily functions.

Incremental validity of the Rorschach Prognostic Rating Scale over the MMPI Ego Strength Scale and IQ

A recent meta-analysis found that the Rorschach Prognostic Rating Scale (RPRS) had a strong ability to predict subsequent outcome (r = .44, N = 783; Meyer & Handler, 1997, this issue). However, that review did not directly address questions of incremental validity. This article focuses on the ability of the RPRS to predict outcome after taking into account other sources of data. Across studies that examined both the RPRS and the MMPI Ego Strength scale, the RPRS had a strong ability to predict outcome (r = .40, N = 187), whereas the MMPI scale did not (r = .02, N = 280). Nine studies examined the RPRS along with an intelligence test and allowed direct numerical estimates of incremental validity to be calculated. Across studies, the RPRS demonstrated strong incremental validity after controlling for intelligence (incremental r = .36, N = 358). It is clear that the Rorschach can make unique contributions to understanding clinically relevant processes in ways that self-reports or measured intelligence cannot. Contemporary Rorschach scales should continue to be evaluated for their distinctive and incremental contribution to clinical practice.