Measurement of Personality Structure by the OPD Structure Questionnaire Can Help to Discriminate Between Subtypes of Eating-Disorders

Measuring personality functioning with the 12-item version of the OPD-Structure Questionnaire (OPD-SQS): reliability, factor structure, validity, and measurement invariance in the general population

Background

The assessment of personality functioning is at the core of current dimensional models of personality disorders. A variety of measures from different clinical and research traditions aim to assess basic psychological capacities regarding the self and others. While some instruments have shown reliability and validity in clinical or other selected samples, much less is known about their performance in the general population.

Methods

In three samples representative of the German adult population with a total of 7,256 participants, levels of personality functioning were measured with the short 12-item version of the Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQS). We addressed questions of factor structure, reliability, validity, factorial invariance, and provide norm values.

Results

Confirmatory factor analysis indicated a satisfactory to good model fit. OPD-SQS models were mostly unaffected by variables such as gender, age, or measurement time. As expected, personality functioning was associated with general psychopathology as well as indices of occupational functioning.

Conclusion

The OPD-SQS is a viable measure to assess personality functioning in the general population.

Differences and similarities in personality functioning across different types of eating disorders

Objective

The classification of anorexia nervosa (AN) into subtypes is relevant due to their different symptomatology. However, subtypes (restricting type: AN-R; purging type: AN-P) differ also in terms of their personality functioning. Knowledge about these differences would allow for better treatment stratification. A pilot study indicated differences in structural abilities that can be assessed by the operationalized psychodynamic diagnosis (OPD) system. The aim of this study was therefore to systematically explore differences in personality functioning and personality between the two AN subtypes and bulimia nervosa (BN) using three personality (functioning) constructs.

Methods

A total of N = 110 inpatients with AN-R (n = 28), AN-P (n = 40), or BN (n = 42) were recruited in three clinics for psychosomatic medicine. Assignment to the three groups was performed using a comprehensive questionnaire validated for diagnostic purposes (Munich-ED-Quest). Personality functioning was examined using OPD Structure Questionnaire (OPD-SQ), personality by using the Personality Inventory for DSM-5-Brief Form and Big Five Inventory-10. (M)ANOVAs were used to examine differences across eating disorder groups. In addition, correlation and regression analyses were conducted.

Results

We observed differences on several sub- and main scales of the OPD-SQ. Whereas patients with BN showed the lowest levels, AN-R patients displayed the highest levels of personality functioning. On some sub- and main scales, such as "affect tolerance," the subtypes of AN differed from BN, whereas on the scale "affect differentiation," AN-R, differed from the other two groups. The total eating disorder pathology score of the Munich-ED-Quest best predicted overall personality structure [stand. β = 0.650; t(104) = 6.666; p < 0.001] and self-regulation [stand. β = 0.449; t(104) = 3.628; p < 0.001].

Discussion

Our findings confirm most of the results of the pilot study. These findings can facilitate the development of stratified treatment approaches for eating disorders.

Eating disorder psychopathology: The role of attachment anxiety, attachment avoidance, and personality functioning

OBJECTIVE

Although the relationship between insecure attachment patterns and eating disorder (ED) psychopathology has repeatedly been demonstrated, the underlying mechanisms of this association are not fully understood. Therefore, the current study aimed to examine personality functioning, defined as an impairment in self and interpersonal functioning, as a mediator between attachment insecurity and ED psychopathology.

METHODS

In a representative population-based sample (N = 2508; age range 14-92 years) ED symptomatology, personality functioning, and attachment insecurity (anxiety and avoidance) were assessed. Besides descriptive uni-/bivariate analysis, path analysis was used to test a mediation model while controlling for the effects of age, gender, mental distress, and BMI.

RESULTS

ED symptomatology was associated with lower levels of personality functioning (r = 0.22) and higher levels of attachment anxiety (r = 0.14) but did not correlate with attachment avoidance (r = 0.02). Path analysis revealed that personality functioning fully mediated the effect of attachment anxiety on ED symptomatology: The indirect effect via personality functioning (β = 0.04, p < .001) accounted for 77% of the total effect. Fit indices were excellent. Sensitivity analyses revealed that the main results were mainly applicable to women and the middle age group.

CONCLUSION

The present findings contribute to the growing body of research using dimensional conceptualizations of personality functioning, suggesting that it provides an informative, overarching framework for understanding and treating ED psychopathology. Findings indicate that underlying individual differences, e.g., with respect to insecure attachment configurations, have relevant implications for symptom manifestations. Potential clinical implications and avenues for future research are discussed.

Associations Between Personality Functioning, Childhood Trauma and Non-adherence in Cardiovascular Disease: A Psychodynamically-Informed Cross-Sectional Study

Objective

Although treatment adherence and lifestyle changes significantly improve the prognosis of cardiovascular disease, many patients do not comply with clinician recommendations. Personality functioning appears to be of importance and is hypothesized to be superior to symptom-based measures in explaining individual differences in non-adherence.

Methods

194 cardiology inpatients (mean age = 70.6 years, 60% male) were assessed using self-report measures in a cross-sectional design. Patients were assessed using the short version of the Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS) to measure personality functioning, as well as the Childhood Trauma Screener (CTS), the Patient Health Questionnaire (PHQ-9) for symptoms of depression, and the Generalized Anxiety Disorder Scale-7 (GAD-7). To assess non-adherence we introduced a brief, novel scale.

Results

Non-adherence correlated significant with personality functioning (r = 0.325), childhood trauma (r = 0.204) and depressiveness (r = 0.225). In a stepwise multiple regression analysis with socio-demographic variables inputted into the model, higher deficits in personality functioning, higher levels of childhood trauma, and male gender were associated with non-adherence (adjusted R2 = 0.149, F(3,190) = 12.225, p &lt; 0.01). Level of depressive symptoms, anxiety, age, education, and income showed no significant additional predictive value and were excluded from the model.

Conclusion

In cardiovascular disease, personality functioning, childhood trauma and male gender are associated with non-adherence and appear to be more important than symptom reports of depression and anxiety. This highlights the relevance of basic impairments in intra- and interpersonal functioning in chronic disease, where the patient’s adherence is central.

Assessment of personality functioning in psychosomatic medicine

Background

Personality functioning, also referred to as structural integration, describes basic emotion-related perception and regulation capacities directed towards the self and others. Patients with impairments of personality functioning experience difficulties in self-regulation and interpersonal relations. Although personality functioning has become increasingly important in psychotherapeutic and psychiatric diagnoses and treatment planning, there is little systematic evidence on the role of personality functioning in patients with chronic and somatic diseases. This article reviews empirical studies using standardized assessments of personality functioning in patients with chronic and somatic diseases and discusses the role of personality structure in psychosomatic medicine.

Results

Currently, there are only a limited number of studies using standardized assessments of personality functioning in patients with chronic or somatic diseases. The available evidence points to correlations of personality functioning with pain perception and the development of chronic pain. In addition, patients with lower levels of personality functioning may have difficulties in managing chronic conditions that require enduring changes in health behavior, such as in diabetes or posttransplantation therapy.

Conclusion

The review suggests a systematic link between personality functioning and health behavior in patients with chronic diseases that relate to self-regulation and coping strategies. These findings underline the importance of assessing personality functioning for diagnostics and treatment planning in psychosomatic medicine. Finally, an assessment of personality functioning could be helpful in choosing specific psychotherapeutic treatment strategies; however, more empirical studies are needed to comprehensively prove these assumptions.

Chilean validation of the operationalized psychodynamic diagnosis-structure questionnaire (OPD-SQ) for personality structure

Background

This is the validation of the Operationalized Psychodynamic Diagnosis—Structure Questionnaire (OPD-SQ).

Methods

A clinical sample of 399 adults and a nonclinical general population sample of 50 healthy adults completed measures of depression, attachment, psychiatric symptomatology and distress. Internal consistency and concurrent validity were assessed. Test–retest and Reliable Change Index were also calculated, as was the ability of the OPD-SQ to distinguish between the clinical and general population groups.

Results

High internal consistencies were found; significant differences between clinical and nonclinical samples, and significant associations with psychiatric symptomatology, depression and psychological distress.

Conclusion

The Chilean OPD-SQ has good reliability, and discriminates between clinical and healthy samples.

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.

Selbstberichtete anorektische Essstörungssymptomatik und psychische Struktur

Hintergrund

Bei verschiedenen psychischen Störungsbildern, wie beispielsweise Essstörungen, zeigen sich Einschränkungen in der psychischen Struktur, die sowohl bei Erwachsenen als auch Adoleszenten beschrieben wurden. Bisher liegen jedoch keine empirischen Untersuchungen zur psychischen Struktur bei Adoleszenten bzw. jungen Erwachsenen mit typischen oder subklinischen Formen von Essstörungen vor.

Ziele der Arbeit

Die vorliegende Studie zielt auf die Untersuchung und den Vergleich verschiedener Strukturdimensionen gemäß Operationalisierter Psychodynamischer Diagnostik bei weiblichen Adoleszenten und jungen Erwachsenen mit unterschiedlicher Ausprägung selbstberichteter anorektischer Essstörungssymptomatik ab.

Material und Methoden

Es gingen Daten von 141 weiblichen Adoleszenten und jungen Erwachsenen mit keiner, gering oder ausgeprägter selbstberichteter anorektischer Essstörungssymptomatik ein. Die Probandinnen wurden über die sozialen Netzwerke Facebook und Instagram rekrutiert und mithilfe einer Onlineerhebung befragt. Zum Einsatz kamen der Fragebogen zur Strukturachse der Operationalisierten Psychodynamischen Diagnostik (OPD-SF) sowie das Eating Disorder Inventory‑2 (EDI-2).

Ergebnisse

Adoleszente und junge Erwachsene mit ausgeprägter selbstberichteter anorektischer Essstörungssymptomatik zeigen auf fast allen Skalen des OPD-SF sowie auf sämtlichen Skalen des EDI‑2 signifikant höhere Werte als Adoleszente und junge Erwachsene ohne bzw. mit geringer Symptomatik. Diese Unterschiede bleiben auch nach Kontrolle für das Alter sowie Vorliegen von Vordiagnosen und psychotherapeutischen (Vor)Behandlungen bestehen. Es zeigen sich deutliche Zusammenhänge zwischen den Skalen des OPD-SF und denen des EDI‑2.

Schlussfolgerung

Einschränkungen in der psychischen Struktur scheinen sich bereits bei subklinischen Formen gestörten Essverhaltens zu zeigen, zumindest, wenn diese selbstberichtet ist. Die Ergebnisse unterstützen die Notwendigkeit der frühzeitigen Erkennung von Problemen mit dem Essverhalten und des Einbezugs struktureller Aspekte in die psychotherapeutische Behandlung.