Work addiction and personality organization: Results from a representative, three-wave longitudinal study

BACKGROUND

Several studies have explored the relationship between personality and work addiction, suggesting that individuals with certain mental disorders, including personality disorders such as obsessive-compulsive personality disorder (OCPD), may be more prone to work addiction. However, the characterization of personality organization (PO) among workaholics and its contribution to the persistence of work addiction remains unclear.

METHODS

In this longitudinal study of a representative sample of young adults (N = 1748), we applied the Bergen Work Addiction Scale and the Inventory of Personality Organization.

RESULTS

We found significant correlations between work addiction and identity diffusion, primitive psychological defenses, reality testing, and overall personality disorganization across three waves. A latent class growth analysis revealed three profiles: no work addiction, increasing work addiction, and constant moderate work addiction. Multinomial logistic regression analysis indicated that higher levels of personality disorganization in wave 1 and increases in personality disorganization between waves 1 and 3 were associated with higher odds of belonging to the increasing work addiction group. Similarly, higher overall personality disorganization in wave 1 was associated with higher odds of belonging to the constant moderate work addiction group.

CONCLUSION

These findings suggest that individuals with chronic work addiction have lower levels of PO, and PO declines as work addiction persists. Screenings for work addiction are recommended to prevent potential mental health issues. Future research should explore the influence of workplace characteristics and work motivations on the association between work addiction and personality disorders.

Helping patients master core conflictual relationship themes in psychotherapy

An important component of case formulation is to understand the patient's difficulties in the context of their relationships. The Core Conflictual Relationship Theme (CCRT) method provides a clinical guide for understanding the narratives of relationship conflicts told during therapy. We follow the case of Barbara, a 60 year old with a long history of chronic shyness. Her narratives follow a common CCRT: she wishes to feel safe, but fears that others are out to get her, which makes her withdraw. These patterns have pervasively repeated themselves in the past, present, and across different relationships (self, family, partners, colleagues). The therapist responds carefully by creating safety, tolerating her fears, and working to overcome these CCRT patterns, thus reducing her impulse to withdraw from treatment. Psychotherapists from many theoretical orientations can learn how patients mastering these repetitive negative CCRTs can lead to more adaptive relationship patterns that improve their mental health.

God Representation Types Are Associated With Levels of Personality Organization and Christian Religious Orthodox Culture

ABSTRACT

This exploratory study shows that God representation types are associated with levels of personality organization. Among two Dutch samples of psychiatric patients (n = 136) and nonpatients (n = 161), we found associations between the psychotic, borderline, and neurotic personality organizations, and passive-unemotional, negative-authoritarian, and positive-authoritative God representation types, respectively. Both patients and nonpatients reported positive God representations, but only nonpatients and higher-level functioning patients reported an integrated God-object relation. For persons with personality pathology, the relationship with God can be a struggle and might have a defensive and/or compensating function. In addition to personality organization, Christian religious orthodox culture is a statistical predictor of God representations, but not of anger toward God. We offer suggestions for how psychotherapeutic work with God representations might differ for patients with different levels of personality organization.

Three Dimensional Approaches to Personality Disorders: a Review on Personality Functioning, Personality Structure, and Personality Organization

PURPOSE OF REVIEW

The concept of personality functioning (Alternative DSM-5 Model of Personality Disorders) has led to increased interest in dimensional personality disorder diagnosis. While differing markedly from the current categorical classification, it is closely related to the psychodynamic concepts of personality structure and personality organization. In this review, the three dimensional approaches, their underlying models, and common instruments are introduced, and empirical studies on similarities and differences between the concepts and the categorical classification are summarized. Additionally, a case example illustrates the clinical application.

RECENT FINDINGS

Numerous studies demonstrate the broad empirical basis, validated assessment instruments and clinical usefulness of the dimensional concepts. Their advantages compared to the categorical approach, but also the respective differences, have been demonstrated empirically, in line with clinical observations. Evidence supports the three dimensional concepts, which share conceptual overlap, but also entail unique aspects of personality pathology, respectively.

Levels of personality organization and internal relational patterns

Background

This study aimed to determine whether level of personality organization is associated with a relational pattern present in an autobiographical narrative about an important interpersonal relationship. The main goals were to explore whether and how the components of the internal relationship pattern, and whether and how the configurations of the components, are related to personality organization, when integrated personality organization (IPO) is taken into account.

Participants and procedure

Assessment of the relational patterns was based on the Core Conflictual Relationship Theme (CCRT) – wishes (WS), responses from others (RO), and responses of the self (RS) – as identified from participants’ self-narratives about important relationships (N = 90).

Results

One-way analysis of variance revealed significant differences between groups with different levels of personality organization, according to one wish of self (WS2 To oppose, hurt, control), five responses of others (RO4 Bad; RO5 Rejecting; RO6 Helpful; RO7 Likes me; RO8 Understanding), and three responses of self (RS1 Helpful; RS4 Oppose and hurt others; RS8 Anxious). Considering the configurations of WS + RO + RS, the results indicate that in the borderline personality organization (BPO) group, the WS Libidinal + RO Frustrating + RS Negative pattern is most prevalent, while in the neurotic personality organization (NPO) and IPO groups, the WS Libidinal + RO Fulfilling + RS Negative and the WS Libidinal + RO Fulfilling + RS Positive configurations are most frequent.

Conclusions

The study supports the thesis that component relationship patterns and their configurations might be related to personality organization. The main differences were found between BPO and IPO with NPO placed between them, in a way congruent with Kernberg’s theory.

Change in the core conflictual relationship theme after long-term dynamic psychotherapy

This naturalistic study focuses on changes in central relationship patterns after long-term dynamic psychotherapy (mean duration = 3 years) with experienced psychotherapists. Relationship patterns before and after treatment were assessed according to the core conflictual relationship theme (CCRT) method, which includes 3 components: most frequent wish, response from others, and response of the self. Overall, the main CCRT did not change substantially after therapy. There were, however, a few significant changes for some of the standard cluster categories after therapy. Patients' flexibility regarding their use of different wishes and negative responses from others and the self increased, as did the frequency of positive responses from others and the self. The positive changes in relationship patterns were only rarely related to changes in symptoms and character pathology.

Development and initial validity of the Object Relations Rating Scale

The aim of this study was to report on the development and the initial validation of the Object Relations Rating Scale (ORRS), which is a measure of in-session enactments of object relations that draws on a psychodynamic conceptualization of personality organization. Forty participants were included in the study, distributed among neurotic, borderline and psychotic personality organizations (PO). Results showed that the interrater reliability of this new measure is good. Two tests of criterion validity support the validity of the measure: the ORRS discriminates well between the three PO groups and it correlates in expected ways with five PO dimensions. Finally, ORRS scales that pertain to the degree of in-session object relation enactments correlated with a measure of transference intensity (convergent validity), and correlations with therapists experience were low as expected (discriminant validity).

The impact of level of personality organization on treatment response: a systematic review

This paper provides a systematic review of extant research concerning the association between level of personality organization (PO) and psychotherapy response. Psychotherapy studies that reported a quantifiable association between level of PO and treatment outcome were examined for eligibility. Based on stringent inclusion and exclusion criteria, we identified 18 studies from 13 original data sources. Participants in these studies had a variety of mental disorders, of which mood, anxiety, and personality disorders were the most common. The results of this systematic review converge to suggest that higher initial levels of PO are moderately to strongly associated with better treatment outcome. Some studies indicate that level of PO may interact with the type of intervention (i.e., interpretive versus supportive) in predicting treatment outcome, which suggests the importance of tailoring the level of interpretive work to the level of PO. Yet, at the same time, the limited number of studies available and the heterogeneity of measures used to assess PO in existing research stress the need for further research. Potential implications for clinical practice and guidelines for future research are discussed.

Structural personality organization as assessed with theory driven profile interpretation of the dutch short form of the MMPI predicts dropout and treatment response in brief cognitive behavioral group therapy for axis I disorders

We investigated the validity of theory driven profile interpretation of the MMPI (Hathaway & McKinley, 1943) Dutch Short Form (DSFM; Eurelings-Bontekoe, Onnink, Williams, & Snellen, 2008) as a measure of personality organization (PO) in a naturalistic follow-up study among 576 psychiatric outpatients receiving brief cognitive behavioral group therapy. Results showed that this assessment method was useful in predicting dropout as well as treatment response. Patients with a latent psychotic PO profile and a manifest low-level borderline organization profile were 3 times more likely to drop out than patients with other PO profiles. Patients with a latent psychotic PO profile who continued treatment had deteriorated at 4-month follow-up. Patients with a manifest low-level borderline PO profile who remained in treatment, however, showed considerable therapeutic progress. We conclude that theory driven profile interpretation of the DSFM as an assessment of PO may be useful in predicting dropout and treatment response to cognitive behavioral treatment of Axis I disorders.

Validation of a theory-driven profile interpretation of the Dutch short form of the MMPI using the TAT Social Cognitions and Object Relations Scale (SCORS)

In this study, we investigated the construct validity of the theory-driven profile interpretation of the Dutch Short Form of the MMPI (DSFM; Luteijn & Kok, 1985), an interpretation method aimed at assessing structural features of personality based on Kernberg and Caligor's (2005) views concerning personality organization. We utilized the four dimensions of the Social Cognition and Object Relations Scale (SCORS; Westen, Lohr, Silk, Gold, & Kerber, 1990) as external criteria. Results showed that, congruent with theoretical expectations, the DSFM profiles predicted structural features of personality functioning, especially identity diffusion as measured by the SCORS, after adjustment for the effect of the single scales used to construct the profiles. These findings provide further support for the construct validity of the DSFM profiles to measure structural features of personality organization. We discuss directions for future research and clinical implications.

[For an empirical approach to object relations]

In this article, the authors address the concept of object relations and its place within psychodynamic theories regarding personality and, more specifically, in Kernberg's conceptualization of personality disorders and organization. The authors attempt to demonstrate the relevance of an empirical approach to object relations by presenting some of the instruments that are most considered. The Object Relations Rating Scale (ORRS ; Diguer, 2001), a new assessment instrument that is different from the others in that it assesses the therapeutic interaction as a whole, and that it is coherent with Kernberg's model of intervention and considers the overall relational manifestations. Finally, the authors present satisfying metrological ratings of this new instrument.

[How do conflict and structure present themselves in relationships?]

It is argued that the approaches used up to now for analyzing dysfunctional relationship patterns are more or less explicitly based on a conflict model and therefore not adequate for describing relationships characterized by structural impairments of a patient's personality. Using the concepts of conflict and structure as derived from the Operationalized Psychodynamic Diagnostic system (OPD-2), four principles of a dysfunctional relationship formation are discussed. It is shown that the differentiation of conflict- and structure-related pathology is highly significant with regard to the selection of an appropriate psychotherapeutic strategy. Furthermore, the connections between the OPD axes relationship, conflict, and structure are conceptualized.

Repetition or reparation? An exploratory study of the relationship schemas of child molesters in treatment

This exploratory study examined the relationship patterns of child abusers in treatment by comparing interactions involving the therapist with those involving a parent. Twenty participants were included in the study. The participants' relationship patterns were assessed using the core conflictual relationship theme (CCRT) method. Core schemas were found in interactions involving the therapist and a parent. The two CCRTs found in interactions with parents were often motivated by a desire for closeness or intimacy, to which the parent reacted with rejection or domination. The participants then felt disappointed, depressed, and unreceptive. In relationship episodes involving the therapist, a similar desire for closeness was answered with help and cooperation from the therapist, hence leading the participants to feel self-controlled and self-confident. Furthermore, the therapist's criticism and opposition was often experienced as an indication of care and acceptance.

Childhood trauma and adult interpersonal functioning: a study using the Core Conflictual Relationship Theme Method (CCRT)

OBJECTIVE

This study aimed to examine the long-term correlates of childhood trauma in regard to interpersonal functioning in adulthood.

METHOD

One hundred and nineteen (N=119) subjects from the Austen Riggs Follow-along Study were included in the study. The Traumatic Antecedent Interview scoring method was used to assess 10 types of childhood trauma. Two additional positive variables were also assessed. Interpersonal patterns in adulthood were assessed using the Core Conflictual Relationship Theme Method.

RESULTS

Subjects reporting childhood physical abuse had a higher prevalence of the wish to be hurt, and experienced others as strict and stern. Those reporting physical neglect had a higher prevalence of the need to be comforted. Subjects who had experienced significant separations during childhood later felt less self-confident in interpersonal situations. Results also showed that subjects who had access to a caretaker/confidant had less need for love. A number of additional findings were nominally significant but did not remain so after correction for multiple comparisons.

CONCLUSIONS

The findings indicate that internalized thoughts and affects regarding childhood traumatic events may still play a role long after the time period of the events. Results also suggest that a continuous measurement approach to the study of traumata may provide information not captured by a dichotomous approach.

Interpersonal conflicts in borderline personality disorder: An exploratory study using the CCRT-LU

This exploratory study compared the relationship patterns of 12 patients with borderline personality disorder (BPD) with those of 11 patients without Axis II pathology using the newly developed CCRT-LU. Results showed that the most prevalent wishes of patients with BPD reflect both a desire and a fear of establishing relationships with significant others. Results also showed that BPDs felt dissatisfied and scared, and determined by others, dependent and weak in interpersonal situations. When comparing BPD and non-BPD subjects, results indicated that BPD subjects display fewer wishes to attend to others, perceive others as more loving and subjugating, more often feel dissatisfied and scared, and are less attacking than subjects without BPD.

An exploratory study of child molesters' relationship patterns using the core conflictual relationship theme method

This study examined the relationship patterns of N = 20 child molesters (CM) using the Core Conflictual Relationship Theme (CCRT) method. The relationship patterns of the CMs were compared with those of a control group of N = 20 subjects from an out patient counseling service. Results showed that CMs had significantly less wish to be controlled, hurt, and not responsible than the control group. No significant difference was found between both groups for the CCRT response of other component (RO). For the response of self (RS) component, results indicated that CMs reported more relationship episodes in which they felt respected and accepted and self-controlled and self-confident. The authors suggest that these interactions could be indicators of the CMs'attempts to attribute blame to others and present themselves as victims. It is also suggested that CMs may have core issues involving autonomy and control.