Relationship of sociotropy/autonomy and dependency/self-criticism to DSM-III-R personality disorders

Threatening Beliefs About Self and Others Moderate the Association Between Psychoticism and Psychological Distress

ABSTRACT

Psychoticism is a multidimensional personality construct involving odd or eccentric behavior, quasi-psychotic experiences, mistrust, interpersonal detachment, and liability for schizophrenia-spectrum disorders, as well as significant distress. Recent advances suggest it can be understood as a dimension that is continuously distributed in the population, leading to questions about factors that contribute to distress and dysfunction among people with a schizotypal liability. We investigated in a large nonclinical sample of young adults whether associations between psychoticism and psychological distress would increase in the presence of threatening beliefs. In our study ( N = 2127), we found that the association between psychoticism and psychological distress is moderated by threatening beliefs including self-criticism, fear of compassion, and socially prescribed perfectionism. These results suggest that distress increases among people with schizotypal traits in the context of negative beliefs about self and others. We discuss implications for clinical practice and directions for further research.

Personality–event interaction models of depression

Several theorists have suggested that excessive concerns about social relatedness or autonomous achievement create vulnerabilities to depression in response to negative interpersonal or achievement events, respectively. In this paper, I describe these models and review empirical studies of them. I then discuss a number of methodological and conceptual issues that arise from these studies and that need to be addressed as this research area matures. Finally, I discuss findings that need to be incorporated by these models, which suggest that the relations among personality, events, and depression are more complex, bi‐directional, and recursive.

Rejection Sensitivity and Borderline Personality Disorder Features: The Mediating Roles of Attachment Anxiety, Need to Belong, and Self-Criticism

Rejection hypersensitivity has been considered the core feature of patients with borderline personality disorder (BPD). However, little is known about the possible developmental mechanisms that might explain the association between rejection sensitivity and BPD features. The current study investigated the mediating roles of adult attachment, need to belong, and self-criticism in the association between rejection sensitivity and BPD features in 256 healthy adults. Results indicated that attachment anxiety, need to belong, and self-criticism mediated the association between rejection sensitivity and BPD features. However, attachment anxiety and self-criticism did not moderate the mediated association between rejection sensitivity and BPD features. The findings suggest that individuals with high rejection sensitivity are more likely to be anxiously attached to significant others, which might increase the desire to be accepted by others. To satisfy this elevated need to affiliate with others, these individuals might become more self-critical, which may contribute to high BPD features.

Personality Factors and Depressive Configurations. An Exploratory Study in an Italian Clinical Sample

Introduction: This study focuses on the relationship between personality configurations and depressive experiences. More specifically, the aim of this study is to investigate the relationship between self-criticism and dependency and personality styles or disorders, exploring the association between personality features and depressive symptoms. The two-configurations model of personality developed by Blatt (2004, 2008) is adopted as a reference point in sharing a valid framework and in understanding the results.

Methods: Five instruments are administered to 51 participants with a diagnosis of depressive disorder, in accordance with DSM-IV-TR (American Psychiatric Association, 2000): Self-criticism and dependency dimensions of depression are measured with the Depressive Experiences Questionnaire (DEQ); self-reported depression is assessed with the Beck Depression Inventory-II (BDI-II); observer-rated depression is assessed with the Hamilton Depression Rating Scale (HDRS); personality is assessed with the Clinical Diagnostic Interview (CDI) and the Shedler Westen Assessment Procedure-200 (SWAP-200).

Results: Only self-criticism, and not dependency, is associated with depressive symptoms. In addition, the SWAP Borderline PD Scale and the Dysphoric: Emotionally dysregulated Q-factor emerge as significant in predicting depression.

Conclusions: Findings support the assumption that depressive personality configurations can enhance the vulnerability to developing depression. Theoretical and clinical implications of these results are discussed.

Psychometric Properties of the Revised and Abbreviated form of the Turkish Version of the Dysfunctional Attitude Scale

Dysfunctional attitudes are considered to be important risk factors in the onset and maintenance of depression. Thus, a psychometrically reliable and valid measure is necessary for understanding depression. The Dysfunctional Attitude Scale (DAS) is widely used and has good psychometric properties, but there is no consensus about its factor structure. To examine its psychometric properties and factor structure, a total of 885 individuals consisting of patients with depression and healthy controls were evaluated. After the sample was randomly divided into two subsets, exploratory and confirmatory factor analyses were performed. Then the DAS was abbreviated according to the factor profiles and theoretical background. Analyses indicated two factors, named Perfectionism/Achievement and Need for Approval/Dependency for the revised DAS . Reliability analyses revealed a good internal consistency, and the concurrent validity indicated significant correlations with the Beck Depression Inventory and the Automatic Thoughts Questionnaire.

The Development of Self-Criticism and Dependency in Early Adolescence and Their Role in the Development of Depressive and Anxiety Symptoms

According to Blatt and others (e.g., A. T. Beck), self-definition, or one’s sense of self, and one’s sense of relatedness to others represent core lifespan developmental tasks. This study examined the role of events pertaining to self-definition or relatedness in the development of personality traits from each domain (self-criticism and dependency), and their relationship to the development of depressive and anxiety symptoms. Two hundred seventy-six early adolescents completed a measure of self-criticism and dependency at baseline and again 24 months later, along with measures of depressive and anxiety symptoms. Every 3 months, participants completed a measure of life events, which were coded as self-definitional or relatedness oriented (80% rater agreement, kappa = .70). Structural equation models showed that self-definitional events predicted increases in self-criticism, which in turn predicted increases in depressive symptoms, whereas relatedness events predicted increases in dependency, although dependency was unrelated to change in symptoms.

Personality disorders as an expression of the dimensional polarity in personality development in late adulthood women

Relationships between Axis II personality disorders and Sidney Blatt constructs of dependency and self-criticism were explored in a late adulthood women sample. The sample consisted of 102 women (M = 72.07 years of age, SD = 7.04) who were administered two measures, the Personality Diagnostic Questionnaire-4+ and the Depressive Experiences Questionnaire. The histrionic, dependent, and obsessive-compulsive personality disorder scales are shown to be significant predictors of dependency, and the narcissistic, borderline, and avoidant scales are significant predictors of self-criticism. The application of a dimensional interpersonal approach to psychopathology is discussed.

Paranoia and self-concepts in psychosis: a systematic review of the literature

The purpose of the present study was to review systematically, research exploring the relationship between self-concepts and paranoia in psychosis. A literature search was performed by two independent raters in relevant databases (MedLine, PsychInfo and Web of Science) and articles meeting the inclusion criteria were cross-referenced. Following scrutiny according to inclusion criteria, 18 studies were selected for review. A narrative synthesis of findings, in which methodological variability is discussed, is presented relative to three key areas: the nature of the relationship between paranoia and self-concepts; the association between paranoia and discrepancies in self-concepts; the nature of the relationship between paranoia and self-concepts when other, dimensional aspects of these constructs are taken into account. The systematic literature review indicated relatively consistent findings, that paranoia is associated with more negative self-concepts when measured cross-sectionally. Results are somewhat more mixed in regards to research on paranoia and self-concept discrepancies. Studies investigating dimensional aspects of self-concepts and paranoia yield findings of particular interest, especially in regards to the association indicated between instability of self-concepts and paranoia. Limitations in research and of the present systematic review are discussed. Clinical and theoretical implications of findings are outlined and possible directions for future research are suggested.

Cognitive-personality style as vulnerability to depression in patients with coronary artery disease: roles of sociotropy and autonomy

OBJECTIVE

To investigate whether the cognitive-personality styles of sociotropy and autonomy and their component subscales are useful for explaining depressogenic vulnerability in a population of individuals with coronary artery disease (CAD) and to better understand the psychosocial etiology of depression in CAD. Depression occurs commonly in patients with CAD and is associated with substantial disability.

METHOD

A prospective study of 193 recently hospitalized CAD patients was conducted. Data were collected from medical records and by self-report at 3 (Time 1, T1) and 9 (Time 2, T2) months post discharge. The association between cognitive-personality styles and depression was tested in hierarchical linear regression equations controlling for clinical and demographic confounders.

RESULTS

High levels of autonomy were significantly associated with increased depressive symptomatology at T1 (p < .001) and T2 (p < .001). The association between autonomy and change in depression approached significance (p = .07). Sociotropy was not a significant predictor of depression at any time. The component subscales of the sociotropy and autonomy measures explained more variance in depressive symptomatology at T1 and T2 as well as change in depression than did the composite measures. The perfectionism subscale of autonomy was the most important predictor of depression at T1 and T2 contributing 5.3% and 5.1% of unique variance in depression, respectively. There was a trend for the association between perfectionism and change in depression (p = .06).

CONCLUSION

Cognitive-personality characteristics are an important predictor of depression in recently hospitalized patients with CAD. The findings suggest a clinical benefit in early detection of highly autonomous patients, particularly those who exhibit perfectionism, coupled with appropriate cognitive intervention and collaborative treatment planning.

Autonomy (vs. sociotropy) and depressive symptoms in quitting smoking: evidence for trait-congruence and the role of gender

According to Beck's cognitive theory of depression, autonomy (high achievement concerns) and sociotropy (high interpersonal concerns) are vulnerability factors for depression when achievement or interpersonal stressors, respectively, are experienced. This hypothesis was tested among men and women attempting to quit smoking, an achievement stressor that can provoke depressive symptoms. Smokers recruited from the community (N=210) provided information about their quit attempt through mailed questionnaires. For the 48-h period following the quit, relationships among autonomy, sociotropy, coping, depressive symptoms and lapsing were assessed. Structural equation models supported the trait-congruence hypothesis because greater autonomy, but not sociotropy, was associated with elevated depressive symptoms among both men and women smokers. However, results were stronger for men (beta=.47, p=.0001) than for women (beta=.20, p=.05). After accounting for autonomy's relationship with depressive symptoms, greater autonomy was inversely associated with lapsing among men (beta=-.35, p=.01), but not women. Results point to the potential usefulness of a theoretical approach to understanding relationships between depressive symptoms and smoking cessation, and indicate that autonomous personality may be an important factor in smoking cessation in men.

Empirical evaluation of the assumptions in identifying evidence based treatments in mental health

Extensive analyses of data from the remarkably comprehensive data set established by the Treatment of Depression Collaborative Research Program (TDCRP), initiated and conducted by the National Institute of Mental Health (NIMH), enabled us to examine the contributions of three dimensions of the treatment process (type of treatment, aspects of the therapeutic relationship, and patients' pretreatment personality characteristics) to three assessments of therapeutic change (symptom reduction, reduction of vulnerability, and development of adaptive capacities) evaluated at termination and extended follow-up. The most consistent factors predicting therapeutic gain were the quality of the therapeutic relationship and patients' pretreatment personality dimensions. The implications of these findings for clinical practice, training, and research are discussed.

Stability of the patient-by-treatment interaction in the Menninger Psychotherapy Research Project

Consistent with the call to consider person-by-treatment interactions in intervention research, Blatt (1992) found that anaclitic and introjective patients responded differently to psychoanalysis and supportive-expressive therapy (SEP) in the Menninger Psychotherapy Research Project (MPRP). Psychoanalysis was significantly more effective than SEP in reducing malevolent, destructive imagery on the Rorschach among introjective patients, those patients who are primarily preoccupied with control and self-definition. Conversely, SEP was significantly more effective than psychoanalysis in reducing these malevolent, destructive images among anaclitic patients, those patients who are primarily preoccupied with interpersonal relatedness. The present analyses of data from the MPRP demonstrate the stability of this statistically significant patient-by-treatment interaction even in the subsample of patients for whom the anaclitic-introjective distinction was ambiguous, reaffirming the validity of both the anaclitic-introjective distinction and the importance of considering patient characteristics in psychotherapy research and practice.

Psychoanalysis--with whom, for what, and how? Comparisons with psychotherapy

If psychoanalytic treatment is to survive in the era of evidence-based medicine and managed care systems, empirical evidence is needed to demonstrate its unique nature and effectiveness. To address this need, comprehensive analyses were conducted of data from the Menninger Psychotherapy Research Project (Wallerstein 1986). These analyses addressed three questions: (1) What are the differences in outcome between psychoanalysis (PSA) and supportive-expressive psychotherapy (SEP)? (2) With what types of patient, and in what ways, are these two psychodynamic treatments differentially effective? (3) Are these differences in outcome the consequence of possibly different mechanisms of therapeutic action? PSA was found to contribute significantly to the development of adaptive interpersonal capacities and to the reduction of maladaptive interpersonal tendencies, especially with more ruminative, self-reflective, introjective patients, possibly by extending their associative capacities. SEP, by contrast, was effective only in reducing maladaptive interpersonal tendencies and only with dependent, unreflective, more affectively labile anaclitic patients, possibly by containing or limiting their associative capacities.

A model of risk for major depression: effects of life stress and cognitive style vary by age

Empirical studies increasingly attribute risk for depression to adverse life events, cognitive style, and possibly to the interaction between cognitive style and event type. We present an evidence-based model, developed with independent samples of adults and elderly adults, indicating that risk for major depression associated with these factors varies with age. According to the model, adverse events and need for control, the cognitive style that is a key feature of Beck's concept of autonomy, are significant risk factors for depression in younger adults but not in elderly adults. The cognitive style of sociotropy, characterized by a high need for relatedness and concern about disapproval, is a stable risk factor, independent of age, in posing a risk for depression. The effects of the interactions of adverse event type (achievement events and interpersonal events) and cognitive style in predicting depression each appear to vary with age, expanding prior work, which suggests that adverse events affecting one's personal vulnerability are likely to precipitate depression. Age-specific approaches to reducing risk for major depression are clinically important, and the model presented here suggests that the use of an age-specific perspective would advance research in stress-diathesis models for risk of depression.

Sociotropy, autonomy, and personality disorder criteria in psychiatric patients

Sociotropy and autonomy (Beck, 1983) are sets of beliefs, concerns, and behavioral tendencies that are proposed to create vulnerability to depression and other psychopathology and to influence its manifestation and treatment response. Other theoretical frameworks (Blatt, 1974) have made similar suggestions. We investigated the differential relations of sociotropy and autonomy to dimensional scores for each DSM-III-R personality disorder (PD) in a sample of 188 psychiatric patients, controlling for the other set of characteristics and for the other PDs. Histrionic and dependent PD traits were related specifically to sociotropy. Paranoid, schizoid, schizotypal, and passive-aggressive PD traits were related specifically to autonomy. Borderline, narcissistic, avoidant, and self-defeating PD traits were related significantly and about equally to both sociotropy and autonomy. Obsessive-compulsive PD traits were not related consistently to either. Results were mostly as predicted and suggest that sociotropy and autonomy may be useful constructs for understanding and treating PDs.

Couple functioning in depression: the roles of sociotropy and autonomy

We evaluated the hypothesis that interpersonal relationships of depressed persons would vary as a function of the personality variables sociotropy and autonomy. Depressed psychiatric patients who reported being in a current intimate relationship for at least six months were administered measures of sociotropy, autonomy, and several aspects of relationship functioning. Results indicated that sociotropy was related significantly to patients' reporting their own behavior as demanding and their partners' behavior as withdrawing, whereas autonomy was related to patients' reporting their partners' behavior as demanding and their own behavior as withdrawing. Autonomy also was related to greater relationship dissatisfaction, and there was a trend for autonomy to be related to greater criticism of the partner. The results are consistent with a model in which sociotropy and autonomy increase vulnerability to depression, in part, through their effects on interpersonal relationships.