1
|
Attard S, Valdez-Symonds S, Valdez-Symonds S, Iles A, Maclennan F. Good character: the implications of personality development and psychopathology for citizenship. BJPsych Bull 2024:1-5. [PMID: 39138921 DOI: 10.1192/bjb.2024.60] [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] [Indexed: 08/15/2024] Open
Abstract
The introduction of new legislation in 2006 brought about changes to the way citizenship applications were considered in the UK. Over the intervening years, several hundred children born in the UK have been denied British citizenship as a result of changes to the 'good character' requirement in the legislation - namely its extension to cover all those aged 10 years or older applying for citizenship, including individuals who were born in the UK. As a result of the formulaic way in which this requirement is assessed, citizenship can be denied on the basis of historical patterns of behaviour or offending from childhood. This article will consider whether the current approach to assessment of character in the context of applications for British citizenship is meaningful or appropriate, given developments in our understanding of normative psychological and neurological development and also the impact of psychosocial adversity, trauma, and broader psychopathological or neurodevelopmental conditions.
Collapse
Affiliation(s)
- Stephen Attard
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Andrew Iles
- Surrey and Borders NHS Foundation Trust, Leatherhead, UK
| | | |
Collapse
|
2
|
Vierl L, Wülfing P, Juen F, Hörz-Sagstetter S, Spitzer C, Benecke C. Unravelling inter-relations within and between psychodynamic constructs and psychopathology using network analysis. Personal Ment Health 2024. [PMID: 38886928 DOI: 10.1002/pmh.1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/26/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
Psychodynamic constructs and psychopathology are closely inter-related, but more detailed insight is needed. We investigated these complex inter-relations using network analysis. A Gaussian graphical model in a sample of N = 2232 psychotherapeutic inpatients was estimated. Self-administered questionnaires to assess interpersonal relations (Inventory of Interpersonal Problems-32), psychodynamic conflicts (Operationalized Psychodynamic Diagnosis-Conflict Questionnaire), personality functioning (Operationalized Psychodynamic Diagnosis-Structure Questionnaire-Short Form, Inventory of Personality Organization-Short Form), and psychopathology (Brief Symptom Inventory) were utilized. We investigated the network structure, identified the most inter-related psychodynamic constructs and the psychodynamic constructs with the strongest inter-relations to psychopathology, and explored the clustering of all included constructs. Active and passive conflict processing modes were negatively inter-related in most conflicts. Passive conflict processing modes were more strongly related to psychopathology than active ones in all conflicts, apart from the care versus autarky conflict. Identity diffusion shared the strongest inter-relations within psychodynamic constructs. The psychodynamic constructs that were most strongly related to psychopathology were impairments in self-perception and the passive self-worth conflict. Psychopathology and psychodynamic constructs formed distinct clusters. Our results emphasize the relevance of personality functioning within psychodynamic constructs and in relation to psychopathology.
Collapse
Affiliation(s)
- Larissa Vierl
- Akademie für Psychoanalyse und Psychotherapie München e.V., Munich, Germany
- Department of Psychology, University of Kassel, Kassel, Germany
| | - Philipp Wülfing
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Florian Juen
- Akademie für Psychoanalyse und Psychotherapie München e.V., Munich, Germany
- Department of Psychology, University of the Bundeswehr, Munich, Germany
| | - Susanne Hörz-Sagstetter
- Akademie für Psychoanalyse und Psychotherapie München e.V., Munich, Germany
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Cord Benecke
- Department of Psychology, University of Kassel, Kassel, Germany
| |
Collapse
|
3
|
Vierl L, Hörz-Sagstetter S, Benecke C, Spitzer C, Juen F. All the Same? Different Measures of Personality Functioning Are Similar but Distinct. A Comparative Study from a Psychodynamic Perspective Using Exploratory Graph Analysis. J Pers Assess 2024; 106:314-327. [PMID: 37647512 DOI: 10.1080/00223891.2023.2251150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Abstract
Personality functioning (PF) is a central construct in many theories of personality pathology. Based on psychodynamic theories, two screening questionnaires to assess PF are widely used: The Inventory of Personality Organization-16 item version and the Operationalized Psychodynamic Diagnosis-Structure Questionnaire Short Form. This study aimed to explore the similarities and differences of the two questionnaires in a large clinical sample of N = 1636 psychotherapeutic inpatients. Correlation analyses were conducted to examine the associations between the global scores and between the subscales. The study further used Exploratory Graph Analysis (EGA) to explore the dimensionality of the items. The stability of estimates was evaluated using a bootstrap version of EGA (bootEGA). The results indicated that the two questionnaires are highly correlated, yet not multicollinear, and moderate to large correlations were found between their subscales. EGA revealed six dimensions that fairly represented the original subscales. BootEGA showed that the dimensions and items were stable, except for one item that did not load sufficiently on any dimension. The findings suggest that although the questionnaires are highly correlated, their subscales tap into distinct domains of PF. We discuss implications stemming from these findings for clinical and scientific practice.
Collapse
Affiliation(s)
- Larissa Vierl
- Akademie für Psychoanalyse und Psychotherapie München e.V, Munich, Germany
- Department of Psychology, University of Kassel, Germany
| | - Susanne Hörz-Sagstetter
- Akademie für Psychoanalyse und Psychotherapie München e.V, Munich, Germany
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Germany
| | - Cord Benecke
- Department of Psychology, University of Kassel, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Germany
| | - Florian Juen
- Akademie für Psychoanalyse und Psychotherapie München e.V, Munich, Germany
- Department of Psychology, Universität der Bundeswehr, Munich, Germany
| |
Collapse
|
4
|
Bernardi R, Eidlin M. Clinical Evidence, Triangulation of Perspectives and Contextualization. Part 1: The Beginning of Carla's Treatment. THE PSYCHOANALYTIC QUARTERLY 2024; 93:33-76. [PMID: 38578265 DOI: 10.1080/00332828.2024.2316218] [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: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 04/06/2024]
Abstract
We propose to critically evaluate and strengthen the level of clinical evidence in psychoanalysis, using a strategy of triangulating clinical phenomena from different perspectives and increasing contextual knowledge. Insufficient discussion of alternative hypotheses and limited contextual information are two Achilles heels of psychoanalytic case presentations. We examine the concept and quality standards of clinical evidence in psychoanalysis and related disciplines, with particular attention to the contribution of the three-level model (3-LM). We analyze the case of a patient treated with transference-focused psychotherapy (TFP), making explicit the theoretical-clinical agreements and disagreements of the authors. We discuss the strengths and limitations of triangulation and contextualization, concluding that they make clinical work and psychoanalytic writing more reliable, transparent, auditable, and replicable.
Collapse
Affiliation(s)
| | - Monica Eidlin
- Ricardo Bernardi Juan Benito Blanco 1285 Apto. 602 11 300 Montevideo Uruguay
| |
Collapse
|
5
|
Biberdzic M, Sowislo JF, Cain N, Meehan KB, Preti E, Di Pierro R, Caligor E, Clarkin JF. Establishing Levels of Personality Functioning Using the Structured Interview of Personality Organization (STIPO-R): a Latent Profile Analysis. J Pers Assess 2024:1-13. [PMID: 38563480 DOI: 10.1080/00223891.2024.2330502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 02/17/2024] [Indexed: 04/04/2024]
Abstract
Both the new ICD-11 and the latest Alternative DSM-5 Model for Personality Disorders focus on self and interpersonal functioning as the central feature of personality pathology, also acknowledging that personality disorders are organized along a dimensional continuum of severity. This revised understanding is in line with long-standing psychodynamic conceptualisations of personality pathology, in particular Kernberg's object relations model of personality organization. Despite existing evidence for the clinical utility of the derived Structured Interview of Personality Organization (STIPO-R), empirical support for the identification of clear cut-points between the different levels of personality functioning is missing. For this purpose, a total of 764 adult participants were recruited across two clinical (outpatient and inpatient) settings (n = 250) and two non-clinical (university students and general community) samples (n = 514). Results from the mixture modeling suggested the existence of five groups across the clinical and non-clinical samples that covered: healthy personality functioning, maladaptive personality rigidity, and mild, moderate, and severe levels of personality pathology. All five indicators of personality organization were found to be reliable predictors of personality pathology. Of the five STIPO-R indicators, Aggression and Moral Values had the most discriminative power for differentiating between the Mild, Moderate, and Severe personality disorder groups. Implications of these findings are discussed.
Collapse
Affiliation(s)
- Marko Biberdzic
- Department of Psychology, Bishop's University, Sherbrooke, QC, Canada
| | - Julia F Sowislo
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| | - Nicole Cain
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Kevin B Meehan
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
- Department of Psychology, Long Island University, Brooklyn, New York, USA
| | - Emanuele Preti
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | | | - Eve Caligor
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
- Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, New York, New York, USA
| | - John F Clarkin
- Personality Disorders Institute and Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
| |
Collapse
|
6
|
Akın A, Goth K, Seiffge-Krenke I, Obbarius A, Winter SM, Sarrar L. Operationalized Psychodynamic Diagnostic of Adolescents in Light of the New ICD-11 Model of Personality Functioning: Personality Structure, Psychodynamic Conflicts, and Mental Health Problems. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1095. [PMID: 37508592 PMCID: PMC10378630 DOI: 10.3390/children10071095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023]
Abstract
The International Classification of Diseases and Related Health Problems, 11th Revision introduced a fully dimensional approach to personality disorders which conceptionally converges with the long-standing psychodynamic understanding of psychopathology through underlying intra- and interpersonal impairments. In this study, the diagnostic contributions of the two psychodynamic concepts of personality structure and psychodynamic conflicts were investigated through the comparison of self-report data of 189 adolescents with mental health problems and 321 mentally healthy controls. The study results reveal that adolescents with mental health problems show significantly higher impairments in all four domains of personality structure and significantly higher levels of several psychodynamic conflicts. Further, adolescents with different mental health problems significantly differ regarding the impairments in the personality structure domains and several levels of psychodynamic conflicts. While higher structural impairments are shown in adolescents with eating and anxiety disorders, higher levels of the passive self-worth conflict persist in adolescents with depressive disorders, and higher levels of the passive identity conflict are affecting adolescents with eating disorders. The findings suggest that a standardized diagnostic assessment of personality structure and psychodynamic conflicts in adolescent patients could contribute to a deeper understanding of mental health problems and appropriate treatment planning through the detection of underlying intra- and interpersonal impairments.
Collapse
Affiliation(s)
- Aslı Akın
- Unit for Psychosomatic Medicine, Institute of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité-Medical Heart Center of Charité and German Heart Institute Berlin, 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Kirstin Goth
- Department of Child and Adolescent Psychiatry, Psychiatric University Clinics Basel, 4002 Basel, Switzerland
- Department of Child and Adolescent Psychiatry, University Clinics Saarland, 66421 Homburg, Germany
| | | | - Alexander Obbarius
- Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, 12200 Berlin, Germany
| | - Sibylle M Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Lea Sarrar
- Department of Psychology, Faculty of Sciences, MSB Medical School Berlin, 14197 Berlin, Germany
| |
Collapse
|
7
|
Somma A, Keeley JW, Bach B. Editorial: Community series in ICD-11 personality disorders: utility and implications of the new model, volume II. Front Psychiatry 2023; 14:1199703. [PMID: 37283709 PMCID: PMC10240050 DOI: 10.3389/fpsyt.2023.1199703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Antonella Somma
- School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
- Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Turro Hospital, Milan, Italy
| | - Jared W. Keeley
- Psychology Department, Virginia Commonwealth University, Richmond, VA, United States
| | - Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Slagelse Psychiatric Hospital, Slagelse, Denmark
| |
Collapse
|
8
|
Riegel KD, Schlosserová L, Blüml V, Waschulin L, Rosová L. Ability to assess the severity of personality psychopathology based on the Structured Interview of Personality Organization (STIPO) in master's students of "Addictology". Acta Psychol (Amst) 2023; 234:103867. [PMID: 36809718 DOI: 10.1016/j.actpsy.2023.103867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 12/04/2022] [Accepted: 02/13/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND With the development of multidisciplinary addictology teams, the ability of an addictologist to reliably assess personality psychopathology can be considered an important prerequisite that significantly enters the process of treatment planning. AIMS Verification of the reliability and validity of the assessment of personality psychopathology in master's students of Addictology (addiction science) based on the Structured Interview of Personality Organization (STIPO) scoring course. METHODS 31 Master's students of Addictology independently evaluated 7 STIPO protocols based on recordings. The presented patients were unknown to the students. The resulting scores of students were compared with 1. expert scores of a clinical psychologist with extensive experience with the STIPO; 2. scores of 4 psychologists without previous experience with the STIPO who have attended the course; 3. information on previous clinical experience and education of the students. The comparison of scores was performed using a coefficient of intraclass correlation, a social relation model analysis and linear mixed-effect models. RESULTS Students demonstrated a high degree of inter-rater reliability with a significant degree of agreement in patient assessments, as well as a high to satisfactory degree of validity in the STIPO assessments. An increase in validity after the individual phases of the course was not proven. Their evaluations were generally independent of previous education, as well as diagnostic and therapeutic experience. CONCLUSIONS The STIPO seems to be a useful tool to facilitate the communication of personality psychopathology between independent experts within multidisciplinary addictology teams. Training in the STIPO can be a useful addition to the study curriculum.
Collapse
Affiliation(s)
- Karel D Riegel
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 4, 128 00 Prague 2, Czech Republic.
| | - Lucia Schlosserová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 4, 128 00 Prague 2, Czech Republic.
| | - Victor Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| | | | - Lívia Rosová
- Department of Applied Mathematics and Statistics, Faculty of Mathematics, Physics and Informatics, Comenius University, Bratislava, Slovakia.
| |
Collapse
|
9
|
Buchheim A, Kernberg OF, Netzer N, Buchheim P, Perchtold-Stefan C, Sperner-Unterweger B, Beckenbauer F, Labek K. Differential neural response to psychoanalytic intervention techniques during structural interviewing: A single-case analysis using EEG. Front Hum Neurosci 2023; 16:1054518. [PMID: 36684843 PMCID: PMC9846161 DOI: 10.3389/fnhum.2022.1054518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/02/2022] [Indexed: 01/05/2023] Open
Abstract
Background Previous studies detected changes in the electroencephalographic (EEG) signal as an effect of psychoanalytic interventions. However, no study has investigated neural correlates of specific psychoanalytic interventions in the EEG power spectrum yet. In the present case study, we contrasted three types of interventions (clarification, confrontation, and interpretation) and a neutral control condition during a structural psychoanalytic interview conducted while EEG was recorded. Methods A 27-year-old male patient diagnosed with major depressive disorder and borderline personality disorder with recurrent suicidal and self-injurious behavior underwent a structural interview while recording EEG. Two independent experts selected by consensus the characteristic episodes of the four conditions (clarification, confrontation, interpretation, and neutral control) within the interview, which were included in the EEG analyses. Fast Fourier transformation (FFT) was applied to subsegments of the intervention type to analyze the EEG power spectra. Alpha and beta power from central, frontal, and parietal sites were considered in linear mixed-effects models with segments as a random factor with maximum-likelihood estimates due to the lack of balance in the length of the interview segments. Results The interventions "interpretation" and "confrontation" showed a significantly lower alpha power compared with the control condition in the central electrodes. In the frontal and parietal sites of the alpha power and all beta power sites, the omnibus tests (full model/model without intervention) and comparisons relative to control conditions showed no significant overall result or failed significance after alpha error correction. Conclusion Incisive interventions, such as confrontation with discrepancies and interpretation of unconscious intrapsychic conflicts, may have provoked temporary emotional lability, leading to a change in psychic processing akin to interference from external stimuli. This conclusion is consistent with the finding that interpretations, which are potentially the most concise interventions, had the strongest effects on alpha power. Using EEG during therapeutic psychoanalytic intervention techniques might be a helpful tool to evaluate differential responses to the psychotherapeutic process on a neural level. However, this single-case result has to be replicated in a larger sample and does not allow generalizations.
Collapse
Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria,*Correspondence: Anna Buchheim,
| | - Otto F. Kernberg
- New York-Presbyterian Hospital–Westchester Division, New York, NY, United States
| | - Nikolaus Netzer
- Hermann Buhl Institute, University of Innsbruck, Eurac Research, Innsbruck, Austria,Eurac Research, Bolzano, Italy
| | - Peter Buchheim
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | | | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | | | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
10
|
Vierl L, Von Bremen C, Hagmayer Y, Benecke C, Sell C. How are psychodynamic conflicts associated with personality functioning? A network analysis. Front Psychol 2023; 14:1152150. [PMID: 37151325 PMCID: PMC10155610 DOI: 10.3389/fpsyg.2023.1152150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Personality functioning and psychodynamic conflicts are central constructs in psychoanalytic theories of psychopathology as well as in many psychodynamic treatment models. Although there has been a longstanding conceptual discussion on how they relate to each other, empirical evidence on this question is still scarce. In this study, we explore the associations between psychodynamic conflicts and levels of structural integration (which can be used synonymously with personality functioning) by means of a partial correlation network analysis in a sample of N = 220 outpatients interviewed and rated according to Operationalized Psychodynamic Diagnosis (OPD-2). We examined network centrality, bridge centrality, clustering, and network stability. The network analysis resulted in separate clusters for levels of structural integration and conflicts, supporting the assumption of distinct psychodynamic constructs. The greatest association between the two clusters was found between the individuation vs. dependency conflict (C1) and the structural capacity to attach to internal objects. In general, C1 showed significantly greater connections with structural dimensions compared to the other five OPD conflicts included. C1 was also more central in the network compared to most other conflicts, whereas the structural dimensions did not differ in centrality. All structural dimensions were found to be strongly interconnected. C1 showed exclusively negative edges to the other conflicts, suggesting that a profound C1 decreases the probability of other psychodynamic conflicts. We discuss clinical as well as conceptual implications of our findings for psychodynamic diagnosis and treatment.
Collapse
Affiliation(s)
- Larissa Vierl
- Department of Psychology, University of Kassel, Kassel, Germany
- Akademie für Psychoanalyse und Psychotherapie München e.V., Munich, Germany
- *Correspondence: Larissa Vierl,
| | - Charlotte Von Bremen
- Georg-Elias-Mueller Institute of Psychology, University of Göettingen, Göttingen, Germany
| | - York Hagmayer
- Georg-Elias-Mueller Institute of Psychology, University of Göettingen, Göttingen, Germany
| | - Cord Benecke
- Department of Psychology, University of Kassel, Kassel, Germany
| | - Christian Sell
- International Psychoanalytic University Berlin, Berlin, Germany
| |
Collapse
|
11
|
Simon J, Bach B. Organization of Clinician-Rated Personality Disorder Types According to ICD-11 Severity of Personality Dysfunction. Psychodyn Psychiatry 2022; 50:672-688. [PMID: 36476023 DOI: 10.1521/pdps.2022.50.4.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: The International Classification of Diseases, 11th edition (ICD-11) model of personality disorders (PD) allows clinicians to classify personality dysfunction according to four levels of severity. This approach is partially inspired by Kernberg's levels of personality organization, in which various PD types are organized according to their level of severity. This study sought to investigate whether the established ICD-10 PD categories can be organized according to the four levels of ICD-11 PD severity, and to what extent this organization aligns with Kernberg's four levels of personality organization. Method: A sample of 247 patients were rated by their mental health professionals according to ICD-10 PD categories and ICD-11 PD severity levels. Results: The frequencies of ICD-10 PDs on the different ICD-11 PD severity levels were generally found to be consistent with Kernberg's model. Accordingly, borderline and antisocial PDs predominantly occurred at the most severe levels, whereas anankastic, avoidant, and dependent PDs typically occurred at the milder levels. Only paranoid and histrionic PDs were less consistent with Kernberg's model. Conclusions: The findings indicate that the new ICD-11 PD severity dimension largely aligns with Kernberg's model of personality functioning with respect to the organization of PD types. Clinicians may therefore conceptualize familiar PD types in terms of their ICD-11 PD severity and vice versa.
Collapse
Affiliation(s)
- Jonatan Simon
- Psychology student at the Faculty of Health Sciences, University of Southern Denmark at the time of writing; he is currently a clinical psychologist at Region Zealand Mental Health Services
| | - Bo Bach
- Senior Research Associate at the Psychiatric Research Unit, Center for Personality Disorder Research (CPDR), Mental Health Services, Region Zealand, Denmark and Associate Professor at the University of Southern Denmark
| |
Collapse
|
12
|
Ulvestad DA, Selsbakk Johansen M, Hartveit Kvarstein E, Pedersen G, Wilberg T. A borderline focused Reflective Functioning measure - Interrater reliability of the Mentalization Breakdown Interview. Nord J Psychiatry 2022; 77:360-366. [PMID: 36244024 DOI: 10.1080/08039488.2022.2123040] [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] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Mentalizing difficulties can be considered the core psychopathology of borderline personality disorder (BPD). Typical failures of mentalizing are targets in therapy for BPD. They are related to severe distress, relational problems, self-destructive behaviors, violence, or substance misuse. A major obstacle in BPD treatment research is the lack of suitable and easily administrated methods to assess mentalizing ability during treatment. The Mentalization Breakdown Interview (MBI) is a new method for capturing episodic mentalizing difficulties occurring in close relationships. Interviews are videotaped and scored in accordance with the Reflective Functioning Scale (MBI-RF). In this way the patients' ability to retrospectively reflect over such episodes are evaluated. This study investigates the interrater reliability of MBI-RF. METHODS The study includes videotapes of MBIs from 32 patients with BPD in an outpatient clinic specialized on mentalization-based treatment (MBT). The MBIs were performed by MBT therapists. Three certified raters scored MBI-RF. RESULTS The interrater reliability was good for MBI-RF. CONCLUSIONS The MBI is promising as a BPD-focused method for the assessment of Reflective Functioning.
Collapse
Affiliation(s)
- Dag Anders Ulvestad
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Outpatient Clinic for Specialized Treatment of Personality Disorders, Oslo University Hospital, Oslo, Norway
| | - Merete Selsbakk Johansen
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Outpatient Clinic for Specialized Treatment of Personality Disorders, Oslo University Hospital, Oslo, Norway
| | - Elfrida Hartveit Kvarstein
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Geir Pedersen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Network for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Theresa Wilberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section for Treatment Research, Department for Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
13
|
Bach B, Mulder R. Clinical Implications of ICD-11 for Diagnosing and Treating Personality Disorders. Curr Psychiatry Rep 2022; 24:553-563. [PMID: 36001221 DOI: 10.1007/s11920-022-01364-x] [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] [Accepted: 08/10/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW The International Classification of Diseases 11th revision (ICD-11) introduced a new approach to personality disorders and related traits. This paper reviews recent literature on the assessment of ICD-11 personality disorders and implications for clinical diagnosis, decision-making, and treatment. RECENT FINDINGS We reviewed findings on two measures developed for the ICD-11 model of personality dysfunction and six inventories for the ICD-11 trait specifiers. The psychometric qualities of these tools are promising, and they allow for both rapid screening and fine-grained assessment. Implications for clinical diagnosis and treatment of personality disorders are reviewed including utility for forensic practice. Based on evidence and our experience, we provide some recommendations for severity- and trait-informed interventions. Initial evidence supports the available instruments for assessing ICD-11 personality disorders. More research is needed including development of clinician-rating forms and diagnostic interviews as well as treatment protocols and trials based on the new ICD-11 classification.
Collapse
Affiliation(s)
- Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Region Zealand Psychiatry, Fælledvej 6, Bygning 3, 4200, Slagelse, Denmark. .,Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| |
Collapse
|
14
|
Maerz J, Buchheim A, Rabl L, Riedl D, Viviani R, Labek K. The interplay of Criterion A of the Alternative Model for Personality Disorders, mentalization and resilience during the COVID-19 pandemic. Front Psychol 2022; 13:928540. [PMID: 35959052 PMCID: PMC9358045 DOI: 10.3389/fpsyg.2022.928540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/04/2022] [Indexed: 01/07/2023] Open
Abstract
Background and aims The COVID-19 pandemic has been accompanied by a worsening of mental health levels in some, while others manage to adapt or recover relatively quickly. Transdiagnostic factors such as personality functioning are thought to be involved in determining mental health outcomes. The present study focused on two constructs of personality functioning, Criterion A of the Alternative Model for Personality Disorders (AMPD, DSM-5) and mentalization, as predictors of depressive symptoms and life satisfaction during the COVID-19 pandemic. A second focus of the study was to examine whether this relationship was mediated by resilience. Methods Linear regression analyses were used to examine the relationship between personality functioning measured by Criterion A (AMPD, DSM-5) and mentalizing abilities as predictors, and depression and life satisfaction as mental health outcomes. To assess the hypothesis that this relationship is mediated by resilience a structural equation modeling approach was conducted. Data from N = 316 individuals from the general population were collected. Results Linear regression models revealed highly significant associations between Criterion A/mentalization and both outcome measures. Structural equation models showed a significant partial mediation by resilience of these relationships. Conclusion Our results support the hypothesis that mentalizing serves as a protective function by promoting resilience to the impact of stress and threats. Criterion A and mentalization performed similarly as predictors of mental health outcomes, providing empirically overlapping operationalizations of personality functioning. This finding emphasizes the importance of personality functioning in positive and negative mental health outcomes. Furthermore, our results are consistent with a mediating role of resilience.
Collapse
Affiliation(s)
- Jeff Maerz
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Luna Rabl
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - David Riedl
- University Hospital of Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
| | - Roberto Viviani
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- *Correspondence: Karin Labek,
| |
Collapse
|
15
|
Assessment of personality functioning in psychosomatic medicine. Wien Klin Wochenschr 2022; 134:602-610. [PMID: 35344100 PMCID: PMC9418278 DOI: 10.1007/s00508-021-01993-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/30/2021] [Indexed: 11/21/2022]
Abstract
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.
Collapse
|
16
|
Barkauskienė R, Gaudiešiūtė E, Adler A, Gervinskaitė-Paulaitienė L, Laurinavičius A, Skabeikytė-Norkienė G. Criteria A and B of the Alternative DSM-5 Model for Personality Disorders (AMPD) Capture Borderline Personality Features Among Adolescents. Front Psychiatry 2022; 13:828301. [PMID: 35479485 PMCID: PMC9035636 DOI: 10.3389/fpsyt.2022.828301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022] Open
Abstract
The recent development of a dimensional view toward personality disorder opens up the field of personality research based on the constructs of personality functioning (Criterion A) and maladaptive personality traits (Criterion B) as core components of personality pathology. However, little is known about the roles of these aspects in relation to borderline personality features during adolescence. The current study aimed at exploring the associations of Criterion A and B and their contribution in predicting borderline personality features in adolescence. A sample of 568 adolescents aged 11-17 (M = 14.38, SD = 1.57; 42.4% males) from different backgrounds (community-based, psychiatric inpatients, and youth forensic care) completed a set of questionnaires among which were measures of personality functioning, maladaptive personality traits, and borderline personality features. The findings reveal that Criterion A and B are strongly interrelated and both are significant in predicting borderline personality features in adolescents. Further, the results showed the incremental value of Criterion A beyond the level of underlying psychopathology and maladaptive personality traits suggesting the distinctive function of Criterion A to capture the features of borderline personality. These findings extend the knowledge about the dimensional aspects of personality pathology in adolescence. The implications in relation to the new personality disorder model in the ICD-11 are highlighted.
Collapse
Affiliation(s)
| | | | - Asta Adler
- Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | | | | | | |
Collapse
|
17
|
Riegel KD, Schlosserova L, Zbornik TS. Self-reported narcissistic traits in patients with addiction through the lens of the ICD-11 model for personality disorders. Front Psychiatry 2022; 13:1041480. [PMID: 36506455 PMCID: PMC9732545 DOI: 10.3389/fpsyt.2022.1041480] [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: 09/11/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is a presumption that pathological narcissism, or narcissistic personality disorder per se, can be considered a precursor to addiction. Although the ICD-11 model does not distinguish specific personality disorders, narcissistic psychopathology should be captured through personality trait qualifiers. OBJECTIVES To verify the capacity of the ICD-11 model in the detection of narcissistic psychopathology in patients with addiction; to test its discrimination capacity, convergent validity, and specificity toward the gender and the type of addiction. MATERIALS AND METHODS Two samples were employed in the study. Sample 1 (n = 421) consisted of patients with addiction; Sample 2 (n = 567) consisted of general population volunteers. Age range was 18-75 years and a battery of self-assessment questionnaires containing Personality Inventory for DSM-5-Brief Form Plus Modified; Triarchic Psychopathy Measure; Hypersensitive Narcissism Scale; and Level of Personality Functioning Scale-Self-Report was administered by pencil-and-paper method. RESULTS The following was confirmed: (1) capacity of the ICD-11 model in relation to capture narcissistic pathology; (2) the differentiation capacity between the clinical and non-clinical population; (3) gender specificity in relation to grandiose and vulnerable narcissism; (4) the connection between the overall degree of impairment in personality functioning and most of trait qualifiers; (5) certain specifics of patients with addiction in relation to the type of addiction. CONCLUSION Results support the empirical and clinical relevance of the ICD-11 model in capturing narcissistic pathology in addicted patients. Clinical implications concerning assessment and treatment in addiction settings, and certain limits regarding the Anankastia domain are discussed.
Collapse
Affiliation(s)
- Karel D Riegel
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Lucia Schlosserova
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Tadeas S Zbornik
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| |
Collapse
|