Explicit and implicit shame aversion predict symptoms of avoidant and borderline personality disorders

Agency in avoidant personality disorder: a narrative review

Objectives

Avoidant personality disorder (AvPD) is a highly prevalent personality disorder, especially in clinical settings, yet scarcely researched. People diagnosed with AvPD have severe impairments in functioning and suffer greatly, yet we still lack meta-analytic evidence for therapy and only a few RCTs are conducted. Patient factors are the most important for outcome in therapy, in general. Lack of agency might be a core deficit in people diagnosed with AvPD. Their conditions might be improved if we understand their agency better. We review previous research regarding psychological mechanisms and interpersonal relationships that facilitate or hinder agency in AvPD in daily life and psychotherapy.

Methods

Summarizing original literature in a narrative review with reflexive thematic analysis.

Results

People diagnosed with AvPD seem to have significant impairments in their sense of agency due to a lack of emotional awareness, an overweight of inhibiting vs. activating emotions, and difficulties regulating emotions. Difficulties also seem related to high levels of attachment avoidance and fear, creating strong ambivalence in social needs, in addition to a strong tendency to subordinate to others. A weak sense of self with a poor narrative, self-doubt, and harsh self-critique makes a reflexive and intentional stand increasingly difficult for these people.

Conclusion

This review gives a clinically meaningful understanding of core strengths and deficits in the personality functioning of AvPD that can help clinicians map out important therapeutic work, identify barriers to client-agency in therapy, and work through relational difficulties in the therapeutic alliance.

Increasing the Flexibility of Implicit Personality Assessment: An Examination of a Universal Assessment Procedure of the Self

The current studies systematically examined a new version of the Questionnaire-Based Implicit Association Test (qIAT), which minimizes the differences between direct and indirect modes of assessment. Studies 1a (N = 276) and 1 b (N = 238) tested a method that enables an indirect assessment of questionnaires that include only non-reversed items. Studies 2a (N = 255) and 2 b (N = 284) tested a task that substitutes the problematic construct-related category labels with generic, universal categories. These studies, which focused on extraversion, supported the feasibility, reliability and validity of this procedure. Studies 3a-3c (N = 159, 154 and 151, respectively) supported the internal consistency, test-retest reliability and convergent validity of these methods, assessing three well-researched, semantically complex personality scales: Aggressive Humor Style, Need for Closure and Anxiety Sensitivity. Studies 4a (N = 195) and 4 b (N = 283) supported the implicitness of the qIAT, as most respondents were not aware of this task's purpose. In Study 4c (N = 598), participants who reported using antidepressants had lower self-esteem qIAT scores compared to a control group, thus supporting the criterion validity of this task. Taken together, findings suggest that the new qIAT substantially increases the scope of indirect personality assessment.

Testing a new indirect measure of general self-worth: The Self-esteem Questionnaire-based Implicit Association Test

The self-esteem Questionnaire-based Implicit Association Test (SE-qIAT) provides an indirect assessment of general self-worth that is based on the items of the well-validated Rosenberg Self-Esteem Scale (RSES), and the structure of this variant of the IAT enables a clearer interpretation, compared with the conventional self-esteem IAT. Study 1 (N = 224) provided support for the internal consistency, test-retest reliability, and implicit-explicit convergent validity of the SE-qIAT. In Study 2 (N = 305), the correlation of the SE-qIAT with the explicit RSES was replicated, and it was larger than the correlations of the SE-qIAT with other self-reports. As to criterion validity, the SE-qIAT moderated the effect of a mild social threat (being excluded in the Cyberball game) on participants' performance in a subsequent anagram task, and this effect was incremental to the explicit self-esteem assessment. In Study 3 (N = 334), the SE-qIAT correlated positively with the self-esteem IAT and negatively with a measure of depression. The two implicit tasks correlated uniquely with each other, above and beyond the variance they each shared with the explicit RSES. Taken together, these findings provide initial support for the reliability and validity of the SE-qIAT.

Expanding the Scope of Implicit Personality Assessment: An Examination of the Questionnaire-Based Implicit Association Test (qIAT)

Self-report questionnaires can only yield information that people are able and willing to report, but implicit assessment methods are not commonly used in mainstream personality research. The Questionnaire-based Implicit Association Test (qIAT) was designed to address the limitations associated with the conventional self-concept IAT, and it enables an indirect assessment that is based on the items of standard self-reports. The present studies examined the psychometric properties of the qIAT across two personality constructs. Study 1 (N = 528) provided support for the internal consistency, test-retest reliability and convergent and discriminant validity of the qIAT that measured extraversion. Study 2 (N = 164) supported the reliability and validity of the qIAT assessment of conscientiousness, which predicted who returned to complete the second session of the study two weeks later, for which participants were paid in advance. This same prediction effect was marginally significant in Study 3 (N = 200), and across both Studies 2 and 3 the qIAT prediction of the criterion behavior was incremental to the parallel self-report questionnaire. Taken together, findings support the reliability and validity of the qIAT, which enables the indirect measurement of a wide variety of distinct personality constructs, currently measured only by self-report scales.