Trauma-Related Dissociation Is Linked With Maladaptive Personality Functioning

Direct and indirect effects of adverse and protective childhood experiences on symptom improvement in psychotherapy

To investigate the effects of adverse and protective childhood experiences on symptom improvement in outpatient psychotherapy.

We evaluated n = 648 completed outpatient psychodynamic psychotherapies. First, we estimated the rate of symptom improvement for each patient using a two-stage hierarchical linear model. We then calculated the direct and indirect influences of childhood experiences on the improvement rate using a structural equation model. Personality functioning, according to the Operationalized Psychodynamic Diagnosis system, was examined as being a possible mediating factor.

The presence of adverse childhood experiences was directly associated with a slower improvement rate in psychotherapy. Moreover, a higher number of adverse childhood experiences was associated with greater impairments in the ability to communicate as one dimension of personality functioning, which in turn was associated with a slower improvement of symptoms. Protective childhood experiences were associated with fewer impairments in specific dimensions of personality functioning, but had no direct effect on the improvement rate.

Adverse childhood experiences can directly influence the course of psychotherapy. In addition, the communication dimension of personality functioning appears to be a central mediator on which adverse and protective childhood experiences act antagonistically and can thus indirectly affect the improvement rate in psychotherapy.

Subcortical neural mechanisms of childhood trauma impacts on personality traits

This study aims to explore the relationships between childhood trauma (CT), personality traits, and subcortical structures. 171 healthy individuals completed the Childhood Trauma Questionnaire (CTQ), the Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI), and underwent 3D T1-weighted MRI scans. Linear regression analyses indicated the complex relationship between CT, personality traits, and subcortical gray matter volume (GMV). Mediation analyses revealed that the right hippocampal GMV partially mediated the effects of CT on neuroticism. These findings suggest that CT affects the development of the Big Five personality traits, and alterations in subcortical structures are closely related to this process. Altered GMV in the right hippocampus may be a key neural mechanism for CT-induced neuroticism.

From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders

PURPOSE

Atheoretical and descriptive conceptualizations of eating disorders (EDs) have faced substantial criticism due to their limited ability to assess patients' subjective characteristics and experiences, as needed to determine the most appropriate treatment options. The present article provides an overview of the clinical and empirical literature supporting the potential contribution of the Psychodynamic Diagnostic Manual (PDM-2) to both diagnostic assessment and treatment monitoring.

METHODS

Following a discussion of the most relevant shortcomings of current diagnostic models of EDs and a description of the rationale and structure of the PDM-2, evidence supporting the core PDM-2 dimensions of ED patients' subjective experiences (i.e., affective states, cognitive processes, relational patterns, somatic/bodily experiences and states) are examined, alongside their relevance to ED diagnosis and treatment.

RESULTS

Overall, the reviewed studies support the diagnostic importance of these patterns of subjective experiences in EDs, highlighting their potential role as either predisposing or maintaining factors to target in psychotherapy. A growing body of multidisciplinary evidence also shows that bodily and somatic experiences are central to the diagnosis and clinical management of ED patients. Moreover, there is evidence that a PDM-based assessment may enable closer monitoring of patient progress during treatment, with regard to both subjective experiences and symptom patterns.

CONCLUSIONS

The study suggests that current diagnostic frameworks for EDs would benefit from the addition of a person-centered perspective that considers not only symptoms, but also patients' full range of functioning-including their deep and surface-level emotional, cognitive, interpersonal, and social patterns-to improve patient-tailored interventions.

LEVEL OF EVIDENCE

Level V, narrative review.

The Relationship between Traumatic Life Events and Polysubstance Use: Examining the Mediating Role of DSM-5 Level of Personality Functioning and Maladaptive Personality Traits

The experience of traumatic events in childhood is an important risk factor for the initiation and continuation of polysubstance use. This study aimed to examine the mediating role of DSM-5 level of personality functioning and maladaptive personality traits in the relationship between traumatic life events and polysubstance use. We used a mixed sample (N = 290; M_age = 40; SD_age = 12.26; 75.2% males) of patients with substance use disorder (SUD; including 90 mono-drug users and 113 polysubstance users) and non-users (including 87 university students) recruited using convenience sampling method from harm reduction-oriented drug treatment centers and universities respectively in Tehran, Iran. Participants completed the Level of Personality Functioning Scale-Brief Form, the Personality Inventory for DSM 5-Brief Form, and the Life Events Checklist-Revised. The results of structural equation modeling showed that DSM-5 level of personality functioning and maladaptive personality traits partially mediated the relationship between traumatic life events and polysubstance use. Experiencing traumatic events may contribute to the risk of polysubstance use through the effect of global personality dysfunction and specific personality traits. This proposed mediational model must be replicated using a longitudinal design across different populations.

Preliminary validation of a brief PROM assessing psychological distress in patients with malignant mesothelioma: The mesothelioma psychological distress tool-Patients

Objective

Psychological suffering in malignant mesothelioma (MM) differs from that in other cancers because of its occupational etiology, and we aimed to develop specific patient-reported outcome measures to assess it.

Methods

We used a multi-method prospective observational multicentric study (N = 149), and a preliminary questionnaire validation was performed through a Bayesian approach.

Results

Item analysis showed a good internal consistency and reliability (Cronbach alpha = 0.79 [95% CI = 0.74-0.93]. Twenty of the 41 initial items were selected as posterior 95% highest density interval factor loading standardized effect size fell outside of the region of practical equivalence. Bayesian exploratory factor analysis showed a two-factor structure: (1) Trauma-related reactions (TR, 13 items) and (2) Claim for justice (CJ, 7 items), confirmed by the Bayesian confirmatory factor analysis. Latent factors were poorly correlated (Posterior median: 0.13; 95% CI = -0.079 to 0.323). The 90% root mean square error of approximation posterior median was 0.04 [90% CI = 0.03-0.58]; the 90% chi-square posterior median was 242 [90% CI = 209-287].

Conclusion

Psychological suffering in MM patients implies negative cognitive, emotional, and somatic reactions related to the traumatic impact of the disease and the need to obtain justice through economic compensation. Our findings provide preliminary evidence that the Mesothelioma Psychological Distress Tool-Patients could be a promising and reliable instrument to assess MM patients' psychological distress.

Maladaptive personality traits may link childhood trauma history to current internalizing symptoms

Research supports a strong relationship between childhood maltreatment and internalizing psychopathology (e.g., anxiety and depression), and features of personality are assumed to explain some of this relationship. In this study, we proposed a model in which maladaptive traits mediate the effect of childhood trauma history on internalizing symptoms in adult individuals. A mixed sample (N = 462) composed of 142 psychiatric patients and 320 community-dwelling individuals completed the Childhood Trauma Questionnaire (CTQ), the Personality Inventory for DSM-5 (PID-5), and the Symptom Checklist (SCL-27) for internalizing psychopathology. The effect of childhood traumas explained 34% of the variance in internalizing symptoms while controlling for the influence of age and gender. The traits accounted for 78% of this effect, which was predominantly exerted through the domains of Negative Affectivity, Detachment, and Psychoticism, and specifically through the facets of Depressivity, Suspiciousness, Anxiousness, Perceptual Dysregulation, and Distractibility. This finding provides preliminary support for the proposed model indicating that the aforementioned maladaptive trait domains potentially function as mediating links by which childhood traumas are translated into internalizing symptoms in adulthood. However, these findings must be interpreted with caution due to the cross-sectional and retrospective mono-method design of this study. Clinical implications are discussed in relation to transdiagnostic treatment and the potential value of specifying trait domain specifiers in ICD-11 and DSM-5 models of personality disorders.

A qualitative study exploring barriers and facilitators to establishing nurse-led, multidisciplinary psychological care for trauma patients: experiences from doctors and nurses

Background

Trauma patients are often in a state of psychological stress, experiencing helplessness, sadness, frustration, irritation, avoidance, irritability and other adverse emotions. Doctors and nurses are at the forefront of caring trauma patients and they play a crucial role in psychological supports and mental health care. However, few qualitative studies had based on the framework of the Theory of Planned Behavior (TPB) to explore the experiences in providing psychological care for trauma patients. We examined attitudinal, normative, and control beliefs underpinning medical staffs’ decisions to perform psychological care.

Method

A qualitative study of in-depth semi-structured interviews was conducted among 14 doctors and nurses engaging in trauma care. The participants came from six tertiary hospitals in Chongqing, China. Data analysis was performed using the approach of Colaizzi. According to the framework of TPB, the researchers identified and summarized the themes.

Results

Important advantages (mutual trust, patients' adherence and recovery), disadvantages (workload, short-term ineffective, practice unconfidently), referents (supportive: managers, patients, kinsfolk, nursing culture; unsupportive: some colleagues and patients), barriers (insufficient time or energy, resources situations), and facilitators (access to psychologist, training/education, reminders) were identified. Some demands, such as training diversity, multidisciplinary cooperation and families' support, reflected by doctors and nurses were important for them to carry out psychological care.

Conclusion

According to the TPB, this article explored the internal and external promotion and hindrance factors that affecting the intentions and behaviors of doctors and nurses in implementing psychological care for trauma patients. We also focused on the experience and demands of health professionals in conducting psychological care, which could provide references for managers to formulate corresponding psychological care procedures and norms.

Dissociation and Dissociative Disorders Reconsidered: Beyond Sociocognitive and Trauma Models Toward a Transtheoretical Framework

For more than 30 years, the posttraumatic model (PTM) and the sociocognitive model (SCM) of dissociation have vied for attention and empirical support. We contend that neither perspective provides a satisfactory account and that dissociation and dissociative disorders (e.g., depersonalization/derealization disorder, dissociative identity disorder) can be understood as failures of normally adaptive systems and functions. We argue for a more encompassing transdiagnostic and transtheoretical perspective that considers potentially interactive variables including sleep disturbances; impaired self-regulation and inhibition of negative cognitions and affects; hyperassociation and set shifts; and deficits in reality testing, source attributions, and metacognition. We present an overview of the field of dissociation, delineate uncontested and converging claims across perspectives, summarize key multivariable studies in support of our framework, and identify empirical pathways for future research to advance our understanding of dissociation, including studies of highly adverse events and dissociation. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Childhood Traumatic Experiences and Dimensional Models of Personality Disorder in DSM-5 and ICD-11: Opportunities and Challenges

PURPOSE OF REVIEW

Childhood trauma is an important risk factor for the development of personality disorders (PDs), yet most research has been devoted to categorical models of personality pathology. Considering the introduction of a dimensional PD model with ICD-11, we review current findings related to various forms of childhood trauma, and PDs, operationalized in the form of personality functioning and maladaptive traits. We focus on the magnitude of associations and examine specific relationships between emotional and physical trauma with areas of personality functioning and single traits.

RECENT FINDINGS

Two studies showed a strong association between childhood trauma and personality dysfunction. Seven studies, including clinical and forensic samples, demonstrated heterogeneous associations between various forms of childhood trauma and maladaptive traits. Overall, four studies indicated a slightly stronger association between personality dysfunction, maladaptive trait expression, and higher levels of emotional trauma than for physical or sexual trauma. Regarding specific trait domains and childhood trauma, most studies yielded the strongest associations for either psychoticism or detachment. Research on childhood trauma and dimensional PD models (i.e., personality functioning and traits) has the potential to contribute to a better understanding of their complex relationship. However, high intercorrelations among different types of childhood trauma, areas of personality functioning, and trait domains increase the difficulty of disentangling single effects. More research is needed including clinical and non-Western samples, especially considering the upcoming ICD-11 classification.

Dissociation in Patients with Non-Psychotic Mental Disorders

Background

Dissociation is a generally recognized phenomenon in psychology and psychiatry; however, questions are still not fully resolved about the difference between pathological and normal dissociation, as well as the role of dissociation, depending on its aetiology, in the formation of clinical manifestations of mental disorders.

Objective

To complement the existing data about the significance of dissociation in non-psychotic mental disorders.

Design

Using the Dissociative Experience Scale (DES), we screened 62 patients (13 male and 49 female) from the Non-Psychotic Conditions Inpatient Department of the Udmurt Republican Clinical Psychiatric Hospital (Izhevsk, Russia). Nineteen of the patients had mental disorders of organic aetiology and 43 patients had mental disorders of psychogenic aetiology.

Results

Dissociation at the pathological level was detected in 12.9% of the patients, all of them female. Among patients with psychogenic disorders, the proportion of patients with pathological dissociation was more than three times that of patients with organic disorders. Among the particular dissociative phenomena, absorption had the highest average severity, both in the general sample and in each aetiological group of patients, while dissociative amnesia had the lowest average severity. The highest levels of dissociation were found in young female patients who had never been married. In patients with psychogenic disorders, the average dissociation severity was significantly higher than in the general population, while in patients with organic disorders it was significantly lower.

Conclusion

The dissociation phenomenon may play a significant symptom-forming role in young women suffering from non-psychotic mental disorders of psychogenic aetiology. In the case of organic mental disorders, the severity of dissociative manifestations decreases even below the conditionally normal level, which may indirectly indicate the destruction of dissociative physiological mechanisms by an organic brain process.

Risk Factors for Adult Depression: Adverse Childhood Experiences and Personality Functioning

Background: Depressive disorder is one of the main health problems worldwide. Many risk factors have been associated with this pathology. However, while the association between risks factors and adult depression is well established, the mechanisms behind its impact remains poorly understood. A possible, yet untested explanation is the mediating impact of levels of personality functioning, i.e., impairments with regard to self and interpersonal.

Method: Around 162 patients were assessed at the beginning of their therapy, with regard to risk factors, such as sociodemographic, physical, hereditary (Information Form), and adverse childhood experiences (ACE; CTQ). Depressive symptoms (Beck Depression Inventory, BDI) and personality functioning (OPD-SQ) were also measured. Associations between the related variables as well as other possible covariates were examined by means of zero-order correlations and bootstrapping-based mediation analysis.

Results: Of all the risk factors taken into account, level of education and physical illness were associated with depression. On the other hand, the most significant predictor of depressive symptomatology was ACE, and this relationship was mediated by personality functioning. This indicates that patients presenting adverse childhood experiences are more likely to develop deficiencies in personality functioning, which in turn increases their likelihood of developing depressive symptomatology.

Conclusion: These results reaffirm the importance of incorporating risk and vulnerability factors such as personality functioning in understanding depression.

Psychometric properties of the dissociative symptoms scale (DSS) in Italian outpatients and community adults

This study investigated the psychometric properties of the Dissociative Symptoms Scale (DSS) among Italian adults from outpatient and community samples. The DSS is a self-report measure of clinically relevant dissociation in adults. An Italian translation of the DSS was administered with measures of lifetime traumatic experiences, psychoform dissociation, and somatoform dissociation to 175 psychiatric outpatients and 423 individuals from the community. The DSS scores for outpatient and community adults were significantly different and showed good internal reliability, good convergent and construct validity, and a four-factor structure (depersonalization and derealization, gaps in awareness and memory, sensory misperceptions, and cognitive and behavioral reexperiencing) that was consistent with findings from previous research. Therefore, our results support previous research showing that the DSS can be used as a screening measure to assess clinically relevant dissociative experiences.

Traumas and Their Consequences According to Control-Mastery Theory

The aim of this article is to introduce the reader to how control-mastery theory (CMT; Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993), an integrative relational cognitive-dynamic theory of mental functioning, psychopathology, and psychotherapeutic process, understands traumas, their consequences, and their mastery. In the first part of this article, we will present an overview of the debate about the definition of trauma within the different editions of the Diagnostic and Statistical Manual of Mental Disorders. Then, we will focus on the concept of complex traumas and on their consequences on mental health. Finally, we will discuss how CMT conceptualizes traumas and their pathological consequences. We will stress in particular how, according to CMT, in order for a painful experience to become a trauma, its victim has to come to believe that s/he caused it in the attempt to pursue a healthy and adaptive goal. In order to master traumas and disprove the pathogenic beliefs developed from them, people attempt to reexperience situations similar to the traumatic ones in safer conditions while giving them happier endings.

Psychological Distress after a Diagnosis of Malignant Mesothelioma in a Group of Patients and Caregivers at the National Priority Contaminated Site of Casale Monferrato

BACKGROUND

Patients of malignant mesothelioma (MM) and their caregivers face significant physical and psychological challenges. The purpose of the present study is to examine the emotional impact after the diagnosis of MM in a group of patients and familial caregivers in a National Priority Contaminated Site (NPCS).

METHODS

A sample of 108 patients and 94 caregivers received a sociodemographic/clinical questionnaire, the Beck Depression Inventory II, the Davidson Trauma Scale, the Coping Orientation to the Problems Experienced-New Italian Version, and the Defense style questionnaire. The risk of depressive and post-traumatic stress disorder (PTSD) symptoms in relation to the strategies of coping and defense mechanisms was estimated in patients and caregivers separately by logistic regression models.

RESULTS

For patients, a high risk of depression was associated with high usage of Defense Style Questionnaire (DSQ) Isolation (OR: 53.33; 95% CI: 3.22-882.30; p = 0.01) and DSQ Somatization (OR: 16.97; 95% CI: 1.04-275.90; p = 0.05). Other significant risks emerged for some coping strategies and some defenses regarding both depression and trauma in patients and caregivers.

CONCLUSIONS

This research suggests that for both patients and caregivers unconscious adaptive processes have a central role in dealing with overwhelming feelings related to the disease.

Childhood Trauma, Personality, and Substance Use Disorder: The Development of a Neuropsychoanalytic Addiction Model

BACKGROUND

While traditional psychoanalysis has been criticized as insufficient for the treatment of substance use disorder (SUD), recent progress in the field of neuropsychoanalysis has generated new and promising hypotheses regarding its etiology. However, empirical research applying this framework has been sparse.

AIM AND SCOPE

The present overview aims at developing and empirically validating a neuroscientifically informed psychodynamic framework regarding the etiology of SUD. For this purpose, this review provides a concise overview of the most relevant historical and contemporary psychoanalytic theories on SUD etiology. Furthermore, the original research summarized in this paper consists of three studies investigating connections between childhood trauma, primary emotions, personality structure and attachment, as well as their relation to SUD development and treatment.

CONCLUSIONS

The results highlight the empirical validity of the neuropsychoanalytic approach towards SUD etiology. In particular, the findings underscore the conceptualization of SUD as a disorder related to dysfunctional attachment and affect regulation abilities especially linked to increased SADNESS and ANGER dispositions, which mediated the relationship between SUD and traumatic childhood relationships. Based on these findings, a refined model of SUD etiology is proposed, which should be tested in future studies.

A correlation network analysis of dissociative experiences

The interrelationships between the symptom domains of dissociation, such as the loss of continuity in subjective experience, the inability to access personal information, and the distortions about the perception of self and the environment, need to be better understood. In the current study, 2274 adults from Italy completed the Dissociative Experiences Scale-II (DES-II), and their responses were examined within a correlation network analysis framework. Fifteen dissociative experiences showed the strongest associations with the other dissociative experiences included in the measure, and they were selected for further analysis. A partial correlation network was calculated to reveal the associations between such experiences, and a community detection analysis was used to explore whether they formed distinct clusters in the network. Subsequently, a Bayesian network was estimated to examine the direction of the associations among the dissociative experiences, and a directed acyclic graph (DAG) was generated to estimate a potentially causal model of their relationships. The community detection analysis revealed three clusters of experiences that were conceptualized in terms of trance, experiential disconnectedness, and segregated behaviors. Dissociative amnesia was a common denominator of all the three clusters. The analysis of the DAG further suggested that dissociation can be conceptualized as a network in which dissociative experiences are layered into groups of symptoms that interact among them. Cognizance of the configuration and interactions among the dissociative domains and their related symptoms may be critical for better understanding the internal logic behind the dissociative processes and for addressing them effectively in clinical practice.

Early traumatic experiences and their relationship with the emergence of depressive symptoms in adulthood

The aim of this study was the exploration of early traumatic experiences related to emotional abuse, physical abuse, sexual abuse, emotional and physical neglect, as well as the connection of the dimensions of these early traumatic experiences with the experiencing of depressive symptoms in adulthood. A sample of 331 University students in Tirana, 60 males (N = 60) or 18.1% and 271 females (N = 271) or 81.9% completed the online Beck Inventory for Depression (BDI), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). The minimum age of the youth participating in the study was 18 years and the maximum age was 32 years, with an average of 20 years (M = 20.07) and the standard deviation (SD = 1.5). Descriptive, correlational and linear regression analysis were used for data processing through the SPSS 22. The study confirmed the connection between early traumatic experiences and the appearance of depressive symptoms in adulthood (r(329) = .333, p < .001). Among the dimensions of early traumatic experiences, it seems that a stronger connection with the occurrence of depressive symptoms relates to the size of emotional trauma. The size of child sexual trauma is connected to feelings of punishment and suicidal thoughts in adulthood. Early traumatic experiences seem to have a significant impact on how adults express themselves and choose to interact with their environment. Coping with problems of mental health and depression today can be closely related to the early traumatic experiences of juveniles and adults.

Is Our Self Related to Personality? A Neuropsychodynamic Model

The concept and the assessment of personality have been extensively discussed in psychoanalysis and in clinical psychology over the years. Nowadays there is large consensus in considering the constructs of the self and relatedness as central criterions to assess the personality and its disturbances. However, the relation between the psychological organization of personality, the construct of the self, and its neuronal correlates remain unclear. Based on the recent empirical data on the neural correlates of the self (and others), on the importance of early relational and attachment experiences, and on the relation with the brain's spontaneous/resting state activity (rest-self overlap/containment), we propose here a multilayered model of the self with: (i) relational alignment; (ii) self-constitution; (iii) self-manifestation; and (iv) self-expansion. Importantly, these different layers of the self can be characterized by different neuronal correlates-this results in different neuronally grounded configurations or organizations of personality. These layers correspond to different levels of personality organization, such as psychotic (as related to the layer of self-constitution), borderline (as related to the layer of self-manifestation) and neurotic (as related to the layer of self-expansion). Taken together, we provide here for the first time a neurobiologically and clinically grounded model of personality organization, which carries major psychodynamic and neuroscientific implications. The study of the spontaneous activity of the brain, intrinsically related to the self (rest-self overlap/containment) and the interaction with stimuli (rest-stimulus interaction) may represent a further advance in understanding how our default state plays a crucial role in navigating through the internal world and the external reality.

A New Measure for Assessing Substance-Related and Addictive Disorders: The Addictive Behavior Questionnaire (ABQ)

This article evaluates the psychometric properties of a new measure for assessing Substance-Related and Addictive Disorders: the Addictive Behavior Questionnaire (ABQ). The ABQ is a self-report measure composed of two sections: the Severity Index (SI) and the Seven Domains Addiction Scale (7DAS). Materials and methods. A total sample of 698 subjects divided into two groups (515 subjects in the clinical sample and 183 subjects in the control sample), participated in this study. We applied Exploratory Factor Analysis (EFA) to examine features of ABQ construct validity, we used Cronbach’s alpha coefficient to assess its internal reliability, and explored some aspects of its concurrent validity by examining its associations with other measures assessing addictive behaviors and psychopathology. Results and conclusions: results of EFA indicated that all the scales of the ABQ are unidimensional and showed good internal consistency. The correlations between the sections of the ABQ and the other measures used in the current study were significant and in the expected directions. These results suggest that the ABQ has good psychometric properties and allows researchers and clinicians to gather relevant information regarding behaviors, psychopathology and severity of symptoms, for the best clinical reasoning and for planning tailored treatment for each patient.

Depressive Symptoms and Addictive Behaviors in Young Adults After Childhood Trauma: The Mediating Role of Personality Organization and Despair

Background: There is substantial evidence that traumatic experiences in childhood increase the likelihood of mood pathology and addictive behaviors in adolescence and young adulthood. Furthermore, both forms of psychopathology have been linked to deficiencies in personality organization and a common primary emotion core. In this study, we intended to further investigate these interactions by assuming a mediating role of personality organization and despair regarding the relationship between childhood trauma and psychiatric symptom burden later in life. Methods: A total sample of 500 young adults (Age: M = 26; SD = 5.51; 63.2% female) were investigated. Structural Equation Modeling was applied in order to investigate the pathways between the latent variables Childhood Trauma, Structural Deficit, Despair (comprised of the primary emotions SEEKING and SADNESS), as well as symptoms of addiction and depression. Results: The results indicate that the influence of Childhood Trauma on Addictive Behaviors was mediated by Structural Deficit (p < 0.01), whereas its influence on Depressive Symptoms was mediated by Despair (decreased SEEKING and increased SADNESS) (p < 0.01). Furthermore, Addictive Behaviors seemed to be stronger represented in males (p < 0.001). The final model was able to explain 39% of the variance of Addictive Behaviors and 85% of the variance of Depressive Symptoms. Discussion: The findings underline the importance of early experiences in the development of adult affective and personality functioning, which is linked to the development of psychiatric disorders. Regarding clinical practice, addiction treatment might focus on the improvement of personality organization, while treatment of depressed patients should primarily emphasize the restructuring of dysfunctional primary emotion dispositions.