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Pedersen AM, Straarup KN, Holm T, Sawatzki D, Hansen MT, Thomsen DK. Illness and narrative identity: examining past and future life story chapters in individuals with bipolar disorder, diabetes mellitus or no chronic illness. Memory 2024; 32:819-832. [PMID: 38949877 DOI: 10.1080/09658211.2024.2366625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/28/2023] [Indexed: 07/03/2024]
Abstract
The purpose of this study was to investigate whether narrative identity challenges are specific to Bipolar Disorder (BD) as a mental illness or a reflection of living with chronic illness. Nineteen individuals diagnosed with BD, 29 individuals diagnosed with Type 1 Diabetes Mellitus (T1DM) and 25 controls without chronic mental or somatic illness identified past and future life story chapters which were self-rated on emotional tone and self-event connections and content-coded for agency and communion themes. Individuals with BD self-rated their past chapters as more negative and less positive, and their chapters were lower on content-coded agency and communion themes compared to T1DM and controls. There were fewer group differences for future chapters, but BD was associated with lower self-rated positive emotional tone and self-stability connections as well as lower content-coded agency and communion themes. The results indicate that narrative identity is affected in individuals with BD above and beyond the consequences of living with chronic illness. This may reflect distinct effects of mental versus somatic illness on narrative identity.
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Affiliation(s)
- Anne Mai Pedersen
- Department of Psychology, Aarhus University, Aarhus, Denmark
- Center on Autobiographical Memory Research (CON AMORE), Aarhus University, Aarhus, Denmark
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
- National Center for Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Tine Holm
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Dela Sawatzki
- Department of Psychology, Aarhus University, Aarhus, Denmark
- Center on Autobiographical Memory Research (CON AMORE), Aarhus University, Aarhus, Denmark
| | - Marie Tranberg Hansen
- Department of Psychology, Aarhus University, Aarhus, Denmark
- Center on Autobiographical Memory Research (CON AMORE), Aarhus University, Aarhus, Denmark
| | - Dorthe Kirkegaard Thomsen
- Department of Psychology, Aarhus University, Aarhus, Denmark
- Center on Autobiographical Memory Research (CON AMORE), Aarhus University, Aarhus, Denmark
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Talarico JM. A tetrahedral model of autobiographical memory research design. WILEY INTERDISCIPLINARY REVIEWS. COGNITIVE SCIENCE 2023; 14:e1615. [PMID: 35843707 DOI: 10.1002/wcs.1615] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/13/2022] [Accepted: 06/23/2022] [Indexed: 05/20/2023]
Abstract
The field of autobiographical memory can do more to be representative of global populations experiencing and recollecting diverse events across the lifespan. To inspire such work, I present a general model for designing autobiographical memory studies. The tetrahedral model (based on Jenkins, 1979) has at its vertices context (e.g., the situated environment, activated schema, or functional goal), outcomes (e.g., the content and phenomenology of remembering), participants (e.g., the demographic characteristics and traits of the individual), and events (e.g., the lived experiences that comprise an individual's autobiography). Further, the area of the base of the pyramid can represent the time frame under investigation (e.g., the wider the distance, the greater the delay between an experience and its retrieval) and the height of the pyramid can represent the sample size (e.g., nearly flat for a case study, increasingly taller for larger groups) being studied. After applying the model to describe how typical autobiographical memory research is conducted (and briefly identifying the limitations therein), representative models of particularly promising areas of research are highlighted. This article is categorized under: Psychology > Memory.
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Pol SM, Schug F, Chakhssi F, Westerhof GJ. Life stories of patients with personality disorders before and after treatment: Change and stability in agency and communion. Front Psychiatry 2023; 14:1134796. [PMID: 37009106 PMCID: PMC10060533 DOI: 10.3389/fpsyt.2023.1134796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction Studying written life stories of patients with personality disorders (PDs) may enhance knowledge of how they understand themselves, others and the world around them. Comparing the construction of their life stories before psychotherapy to their reconstruction after psychotherapy may provide insight in therapeutic changes in the understandings of their lives. Methods As few studies addressed this topic, the current study explored changes in agency (i.e., perceived ability to affect change in life), and communion (i.e,, perceived connectedness to other persons) in written life stories of 34 patients with various PDs, before and after intensive psychotherapy treatment. Results Life stories showed a positive increase in agency from pre- to posttreatment, in particular regarding internal agency, societal success, and occupational success. No significant changes were observed for communion as a whole. However, the perceived number and quality of close relationships revealed a significant positive increase. Discussion The increased agency in the reconstruction of patients' life story after psychotherapy suggests that patients improved their perceived ability to affect change in their own lives. This can be seen as an important step in the treatment of PDs towards further recovery.
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Affiliation(s)
- Silvia M. Pol
- GGNet Scelta, Apeldoorn, Netherlands
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
| | | | - Farid Chakhssi
- GGNet Scelta, Apeldoorn, Netherlands
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
| | - Gerben J. Westerhof
- GGNet Scelta, Apeldoorn, Netherlands
- Department of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
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Lind M. Situating personality disorder within its maladaptive narrative identity ecology. Front Psychiatry 2023; 14:1117525. [PMID: 36970282 PMCID: PMC10034016 DOI: 10.3389/fpsyt.2023.1117525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/22/2023] [Indexed: 03/29/2023] Open
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Gamache D, Leclerc P, Payant M, Mayrand K, Nolin MC, Marcoux LA, Sabourin S, Tremblay M, Savard C. Preliminary Steps Toward Extracting the Specific Alternative Model for Personality Disorders Diagnoses From Criteria A and B Self-Reports. J Pers Disord 2022; 36:476-488. [PMID: 34985324 DOI: 10.1521/pedi_2012_35_541] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Alternative DSM-5 Model for Personality Disorders (AMPD) retains six specific personality disorders (PDs) that can be diagnosed based on Criterion A level of impairment and Criterion B maladaptive facets. Those specific diagnoses are still underresearched, despite the preference expressed by most PD scholars for a mixed/hybrid classification. This study explores the possibility of using Criterion A and B self-report questionnaires to extract the specific AMPD diagnoses. Plausible prevalence estimates were found in three samples (outpatient PD, private practice, community; N = 766) using the facet score ≥ 2 and t score > 65 methods for determining the presence of a Criterion B facet; diagnoses had meaningful correlations with external variables. This study provides evidence-albeit preliminary-that the extraction of the specific AMPD PDs from self-report questionnaires might be a viable avenue. Ultimately, it could promote the use and dissemination of those diagnoses for screening purposes in clinical and research settings.
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Affiliation(s)
- Dominick Gamache
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,CERVO Brain Research Centre, Quebec City, Quebec, Canada.,Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Montreal, Quebec, Canada
| | - Philippe Leclerc
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Maude Payant
- Department of Psychology, Université du Québec à Montréal, Montreal
| | | | - Marie-Chloé Nolin
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | | | - Stéphane Sabourin
- School of Psychology, Université Laval, Quebec City.,Clinique de Psychologie du Couple, Quebec City
| | | | - Claudia Savard
- CERVO Brain Research Centre, Quebec City, Quebec, Canada.,Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Montreal, Quebec, Canada.,Department of Educational Fundamentals and Practices, Université Laval, Quebec City
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Lind M, Sharp C, Dunlop WL, Mayrand K, Nolin MC, Marcoux LA, Sabourin S, Tremblay M, Savard C. Why, How, and When to Integrate Narrative Identity Within Dimensional Approaches to Personality Disorders. J Pers Disord 2022; 36:377-398. [PMID: 34985340 DOI: 10.1521/pedi_2012_35_540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Researchers and clinicians are beginning to adopt dimensional approaches in the study and treatment of personality disorders (PD). Although dimensional approaches in the DSM-5 and ICD-11 hold considerable benefit, they need to better incorporate an appreciation of individuals' life stories, or narrative identities. Doing so will be necessary to flesh out the emphasis that both frameworks place on the role of identity in personality pathology. In this article, the authors review why, how, and when narrative identity theory and research can be integrated within dimensional approaches to PD. The authors describe established ways to assess narrative identity, review extant research on this construct in relation to PD, and signal areas crucial for future research. Stories lie at the heart of what it means to be human. The authors conclude that a greater consideration of the ways in which the self is storied can help further understanding and treatment of PD.
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Affiliation(s)
- Majse Lind
- University of Florida, Gainesville, Florida
| | | | - William L Dunlop
- University of California, Riverside.,Aarhus University, Aarhus, Denmark
| | | | - Marie-Chloé Nolin
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | | | - Stéphane Sabourin
- School of Psychology, Université Laval, Quebec City.,Clinique de Psychologie du Couple, Quebec City
| | | | - Claudia Savard
- CERVO Brain Research Centre, Quebec City, Quebec, Canada.,Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Montreal, Quebec, Canada
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Jørgensen CR, Bøye R. How Does It Feel to Have a Disturbed Identity? The Phenomenology of Identity Diffusion in Patients With Borderline Personality Disorder: A Qualitative Study. J Pers Disord 2022; 36:40-69. [PMID: 34124947 DOI: 10.1521/pedi_2021_35_526] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Identity diffusion is one of the defining characteristics of borderline personality disorder (BPD). Given its central importance in the formal diagnostic criteria for personality disorders, identity diffusion is remarkably under-researched. In particular, our knowledge of the phenomenology of identity diffusion needs to be improved. This study is based on semistructured interviews with 16 younger women SCID-5-diagnosed with BPD. All interviews were analyzed using the interpretative phenomenological analysis approach. On the basis of this analysis, the patients' descriptions of how identity diffusion manifests itself in their subjective experience are classified into nine categories: disintegrated self-image; using various façades to stabilize the self; painful feelings of the self as broken; feeling that the self does not fit in; inner emptiness; "I don't know what I want"; great need for attention from others to stabilize identity; feeling unable to handle interpersonal relationships; and using sex to distract the self and regulate painful self-states.
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Affiliation(s)
| | - Rikke Bøye
- Clinic for Personality Disorders and Suicide Prevention, Aarhus University Hospital, Skejby, Denmark
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Steen A, Graste S, Schuhmann C, de Kubber S, Braam AW. A Meaningful Life? A Qualitative Narrative Analysis of Life Stories of Patients with Personality Disorders Before and After Intensive Psychotherapy. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2022. [DOI: 10.1080/10720537.2021.2015729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Angelien Steen
- University of Humanistic Studies, Utrecht, the Netherlands
- Centre for Psychotherapy, GGz Centraal, Ermelo, the Netherlands
| | - Sanne Graste
- Centre for Psychotherapy, GGz Centraal, Ermelo, the Netherlands
| | | | - Sylvie de Kubber
- University of Humanistic Studies, Utrecht, the Netherlands
- Parnassia groep, The Hague, the Netherlands
| | - Arjan W. Braam
- University of Humanistic Studies, Utrecht, the Netherlands
- Altrecht, Utrecht, the Netherlands
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Eddy CM. The Transdiagnostic Relevance of Self-Other Distinction to Psychiatry Spans Emotional, Cognitive and Motor Domains. Front Psychiatry 2022; 13:797952. [PMID: 35360118 PMCID: PMC8960177 DOI: 10.3389/fpsyt.2022.797952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/14/2022] [Indexed: 01/18/2023] Open
Abstract
Self-other distinction refers to the ability to distinguish between our own and other people's physical and mental states (actions, perceptions, emotions etc.). Both the right temporo-parietal junction and brain areas associated with the human mirror neuron system are likely to critically influence self-other distinction, given their respective contributions to theory of mind and embodied empathy. The degree of appropriate self-other distinction will vary according to the exact social situation, and how helpful it is to feel into, or remain detached from, another person's mental state. Indeed, the emotional resonance that we can share with others affords the gift of empathy, but over-sharing may pose a downside, leading to a range of difficulties from personal distress to paranoia, and perhaps even motor tics and compulsions. The aim of this perspective paper is to consider how evidence from behavioral and neurophysiological studies supports a role for problems with self-other distinction in a range of psychiatric symptoms spanning the emotional, cognitive and motor domains. The various signs and symptoms associated with problematic self-other distinction comprise both maladaptive and adaptive (compensatory) responses to dysfunction within a common underlying neuropsychological mechanism, compelling the adoption of more holistic transdiagnostic therapeutic approaches within Psychiatry.
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Affiliation(s)
- Clare M Eddy
- Birmingham and Solihull Mental Health NHS Foundation Trust, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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10
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Folmo EJ, Langjord T, Myhrvold NCS, Lind M. Metaphors in Mentalization-Based Treatment: Reintroducing the Language of Change in “Plain Old Therapy”. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2021. [DOI: 10.1007/s10879-021-09512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractMetaphors, a central conduit of change in psychotherapy, have not been taken adequately into account in Mentalization-Based Treatment (MBT). Despite successfully utilized by other evidence-based treatments for borderline personality disorder (BPD), MBT considers metaphors confusing for patients with low mentalizing abilities. For metaphors and teaching stories to stimulate growth within the window of tolerance, interventions should be responsively tailored (e.g., explained). Metaphors might be a route to making spoken matter more apprehensible, and bridge emotions with cognitive content. They hold the potential for challenging without being too confronting, and to translate knowledge between different range of understanding. This theoretical article presents why the use of metaphors in MBT—in the hands of a responsive therapists—may prove a powerful tool to open social trust, despite being considered a “high risk” intervention. The timeless lens of the metaphor may help us connect with archetypical versions of our own narratives, hence understanding our subjectivity in a larger perspective. By reaching towards concepts beyond our normal reasoning, typically denoted perennial philosophy or wisdom, they may substitute and/or supplement mentors in a memorable way.
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Jensen RAA, Thomsen DK, Lind M, Ladegaard N, Bliksted VF. Storying the Past and the Future: Agency and Communion Themes Among Individuals With Schizophrenia and Depression. J Nerv Ment Dis 2021; 209:343-352. [PMID: 33835953 DOI: 10.1097/nmd.0000000000001302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
ABSTRACT Research has linked disturbances in narrative identity with schizophrenia and other psychiatric disorders. One such disturbance is diminished agency and communion themes in past life stories. However, projecting oneself into the future is also central to identity and potentially impacts recovery. Hence, we examined themes of agency and communion in both past and future life stories and related themes to psychosocial functioning in 20 individuals with schizophrenia, 20 individuals with depressive disorder, and 19 nonpsychiatric controls. Participants were asked to describe up to 10 past and future chapters in their life stories and were assessed on psychosocial functioning and neurocognition. Chapters were coded for agency and communion themes. Both clinical groups displayed diminished agency and communion themes in past but not future life story chapters compared with the nonpsychiatric controls. Furthermore, agency themes in future chapters explained variance in psychosocial functioning after controlling for neurocognition. The results suggest that constructing a narrative identity to foster agency and communion in both past and future chapters may be an important part of recovering from schizophrenia and depression.
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12
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Wright L, Lari L, Iazzetta S, Saettoni M, Gragnani A. Differential diagnosis of borderline personality disorder and bipolar disorder: Self-concept, identity and self-esteem. Clin Psychol Psychother 2021; 29:26-61. [PMID: 33811707 DOI: 10.1002/cpp.2591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/28/2020] [Accepted: 03/26/2021] [Indexed: 01/04/2023]
Abstract
Symptoms of borderline personality disorder (BPD) and bipolar disorder (BD) often overlap. In some cases, it is difficult to conduct a differential diagnosis based only on current diagnostic criteria Therefore, it is important to find clinical factors with high discriminatory specificity that, used together with structured or semi-structured interviews, could help improve diagnostic practice. We propose that a clinical analysis of identity, self-concept and self-esteem may help distinguish the two disorders, when they are not co-morbid. Our review of the studies that analyse these constructs in BD and BPD, separately, points in the direction of qualitative differences between the two disorders. In BPD, there is a well-documented identity diffusion, and the self-concept appears predominantly negative; shifts in self-concept and self-esteem are often tied to interpersonal triggers. In BD, patients struggle with their identity, but narrative identity might be less compromised compared with BPD; the shifts in self-concept and self-esteem appear more linked to internal (i.e. mood and motivational) factors. We end the paper by discussing the implications for clinicians and ideas for future comparative research.
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Affiliation(s)
- Livia Wright
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy
| | - Lisa Lari
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy
| | | | - Marco Saettoni
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy.,Unità Funzionale Salute Mentale Adulti, ASL Toscana Nord-Ovest Valle del Serchio, Pisa, Italy
| | - Andrea Gragnani
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy.,Unità Funzionale Salute Mentale Adulti, ASL Toscana Nord-Ovest Valle del Serchio, Pisa, Italy.,Scuola di Psicoterapia Cognitiva SRL, Rome, Italy
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Vanderveren E, Bogaerts A, Claes L, Luyckx K, Hermans D. Narrative Coherence of Turning Point Memories: Associations With Psychological Well-Being, Identity Functioning, and Personality Disorder Symptoms. Front Psychol 2021; 12:623903. [PMID: 33746841 PMCID: PMC7969507 DOI: 10.3389/fpsyg.2021.623903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/08/2021] [Indexed: 12/03/2022] Open
Abstract
Individuals develop a narrative identity through constructing and internalizing an evolving life story composed of significant autobiographical memories. The ability to narrate these memories in a coherent manner has been related to well-being, identity functioning, and personality pathology. Previous studies have particularly focused on coherence of life story narratives, overlooking coherence of single event memories that make up the life story. The present study addressed this gap by examining associations between narrative coherence of single turning point memories and psychological well-being, identity functioning, and personality disorder (PD) symptoms among 333 Belgian emerging adults (72.1% female; M age = 22.56, SD = 3.13, age range = 18-30). In addition, the present study tested whether narrative coherence could predict unique variance in PD symptoms above and beyond identity and interpersonal functioning, both considered key components of personality pathology. The findings showed that narrative coherence was not significantly related to psychological well-being, but yielded significant negative associations with disturbed identity functioning and antisocial PD symptoms. Furthermore, narrative coherence predicted unique variance in antisocial PD symptoms above and beyond identity functioning, but did not predict unique variance in borderline and antisocial PD symptoms above and beyond both identity and interpersonal functioning. Collectively, these findings suggest that narrative incoherence within single event memories might be characteristic for disturbed identity functioning and antisocial personality pathology.
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Affiliation(s)
- Elien Vanderveren
- Department of Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Annabel Bogaerts
- Department of Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Laurence Claes
- Department of Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Koen Luyckx
- Department of Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Dirk Hermans
- Department of Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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Shiner RL, Klimstra TA, Denissen JJA, See AY. The development of narrative identity and the emergence of personality disorders in adolescence. Curr Opin Psychol 2021; 37:49-53. [DOI: 10.1016/j.copsyc.2020.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 01/12/2023]
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Lind M. ICD-11 Personality Disorder: The Indispensable Turn to Narrative Identity. Front Psychiatry 2021; 12:642696. [PMID: 33679490 PMCID: PMC7930739 DOI: 10.3389/fpsyt.2021.642696] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Majse Lind
- Department of Psychology, University of Florida, Gainesville, FL, United States
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How does level of personality functioning inform clinical management and treatment? Implications for ICD-11 classification of personality disorder severity. Curr Opin Psychiatry 2021; 34:54-63. [PMID: 33252430 DOI: 10.1097/yco.0000000000000658] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The International Classification of Diseases, 11th Edition (ICD-11) classifies personality disturbance according to levels of severity. This article reviews the literature on levels of personality functioning in relation to clinical management and treatment, and proposes how these findings apply to the ICD-11 classification of personality disorders. RECENT FINDINGS Findings were primarily derived from studies using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Level of Personality Functioning Scale (LPFS), Kernberg's Level of Personality Organization, and the general P-factor of personality disorder. Severity of personality dysfunction is related to treatment outcome, risk of dropout, therapeutic alliance, readiness for treatment, risk of harm to self or others, risk of dissociation and psychotic-like breaks, coherence in narrative identity, reflective functioning, and epistemic trust. SUMMARY The overall level of personality disorder severity indicates risk of negative outcomes and may be used as decision tool for 'personalized medicine' and required treatment intensity (e.g., strength of alliance and the need for establishing epistemic trust). Beyond the ICD-11 guidelines for determining personality disorder severity, these implications also apply to practitioners using comparable frameworks such as the DSM-5 LPFS and Kernberg's Level of Personality Organization. Future research should focus on the interaction of severity with trait qualifiers in relation to clinical management.
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Abstract
PURPOSE OF REVIEW Identity is one of the key domains that is disturbed in people manifesting personality disorder (PD). Within the field of personality psychology, there is a robust approach to studying identity focused on narrative identity which has been largely overlooked in studying PD. In this paper, a systematic review was conducted of studies published in the past decade that focused on how individuals manifesting personality pathology craft their narrative identity. RECENT FINDINGS This review revealed disturbances related to several motivational/affective themes (e.g., negative valence/valence shifts and thwarted themes of agency and communion), autobiographical reasoning (negative self-inferences), and structural elements (e.g., low coherence and fewer life script events) within the narrative identity of people who manifest PD. Narrative identity is disturbed in people experiencing personality pathology and may have crucial implications for enhancing our conceptual understanding of PD and for PD interventions. This review also points to several research limitations and gaps that we encourage the field to pursue in the future.
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Abstract
After participating in this activity, learners should be better able to:• Assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes• Evaluate the effects of empathy or related processes as factors contributing to abnormal social functioning in BPD ABSTRACT: We reviewed 45 original research studies, published between 2000 and 2019, to assess differences between adult patients with the diagnosis of borderline personality disorder (BPD) and healthy control subjects in terms of empathy and related processes (i.e., theory of mind, mentalizing, social cognition, and emotional intelligence). Thirty-six studies reported deficits of empathy or related processes in patients with BPD. Enhanced emotional empathy in BPD was also reported in eight studies, all of which revealed that patients had increased scores of personal distress on the Interpersonal Reactivity Index self-report questionnaire. Six studies did not find significant differences between patients with BPD and healthy control subjects in terms of empathy or related processes. No study reported enhanced cognitive empathy, social cognition, or emotional intelligence in patients with BPD. We postulate that deficits of empathy or related processes contribute to preempting the formation of stable interpersonal relationships, whereas enhanced emotional empathy might lead to personal (and interpersonal) distress, further contributing to abnormal social functioning in BPD.
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