A Big Five facet analysis of sub-clinical dependent personality disorder (Dutifulness)

This study aimed to examine a Big Five, normal personality trait, "bright side" analysis of a sub-clinical personality disorder: Dependency Personality Disorder. Around 6000 British adults completed the NEO-PI-R which measures the Big Five personality factors at the domain and the facet level. They also completed the Hogan Development Survey (HDS) which has a measure of sub-clinical Dependency Personality Disorder called Dutiful as one of its eleven dysfunctional interpersonal tendencies. Correlation and regression results confirmed many of the associations between the Big Five domains and facets and sub-clinical Dependency. The Dutiful (Dependent) scale from the HDS was the criterion variable in all analyses. The results showed that those high on Dutiful are highly unstable Neurotic, Agreeable people who are low on Openness. They are Anxious, Compliant, Self-Conscious, Unassertive and Vulnerable. It is thus possible to assess subclinical personality disorder "dark-side" traits, like Dutifulness, in terms of normal "bright-side" traits. Limitations of the study are acknowledged.

Cooperation in psychotherapy increases metacognitive abilities: a single-case study

INTRODUCTION

Both clinical observations and empirical data suggest that the ability to think about the mental states of themselves and others (i.e., metacognition) is a crucial factor strongly associated to the outcome of individual psychotherapies. Although it has been hypothesized that the activation of cooperation between patient and psychotherapist within psychotherapy sessions may increase metacognitive abilities, few data is still available to support this hypothesis.

METHODS

We explore the association between cooperation of patient and psychotherapist and the modifications of metacognition abilities along five sessions of a patient with a personality disorder using the Assessing Interpersonal Motivations in Transcripts method (AIMIT) and the Metacognition Assessment Scale (MAS).

RESULTS

Our data showed that the activation of cooperation was positively associated with both the MAS total scores and all MAS sub-scales.

DISCUSSION AND CONCLUSION

Our results demonstrate that the activation of the cooperation within therapeutic relationship can increase patient's metacognition and its subsystem (e.g. self-monitoring).

[On the relationship between emotional dependency and abuse]

Abuse is a complex psychosocial issue with multiple implications. This paper takes a look at the physical and psychological manifestations of domestic violence, i.e. between adult (romantic) partners as well as abuse of the elderly. Past studies have looked at the relationship between emotional dependency, the occurence and sustainability of abuse and the likehood that a victimized person will terminate a relationship. Indeed, individuals with Dependent Personality Disorder (DPD) or with dependent characteristics present a higher risk of becoming abusive (both physically and mentally) as well as becoming a victim of abuse. Regarding the elderly, the concept of "reverse violence"--where the current abuser was the victim of the senior who is being abused-, also entails dependent relationships. We identified three concepts that are necessary in the understanding of how dependent relationships underpin abuse: Rusbult's model of commitment in intimate relationships, the notion of dependency-possessiveness and Murphy et al's notion of escalating affective dependency. Thus, it is imperative that future studies in the field of domestic violence look at the dynamics of dyads rather than the individuals alone.

Metacognitive mastery moderates the relationship of alexithymia with cluster C personality disorder traits in adults with substance use disorders

Cluster C personality disorder traits have been observed in substance use disorders and linked with poorer outcome. One potential factor which may cause these disturbances in personality function is alexithymia, or the inability to name and express emotion. There may be other proximate factors which moderate the impact of alexithymia on the expression of cluster C traits, such as metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems. To examine the possibility that mastery mediated the effects of alexithymia on cluster C traits, we assessed each of these constructs using the Metacognitive Assessment Scale Abbreviated, Toronto Alexithymia Scale and SCID II among 58 adults in an early phase of recovery from substance misuse disorders in a residential setting. Results of a multiple regression revealed that, after controlling for symptom severity and severity of substance misuse history, metacognitive mastery moderated the effect of alexithymia on number of cluster C traits. A median split and subsequent ANCOVA revealed that participants with higher levels of alexithymia and poorer metacognitive mastery had more cluster C traits than the other groups. These findings may have clinical implications, suggesting that patients with substance use disorders may benefit from treatment which addresses metacognitive mastery.

[Affective dependency]

Affective dependency is characterized by emotional distress (insecure attachment) and dependency to another person with a low self-esteem and reassurance need. The paper proposes a reflection on the definition of emotional dependency and the confusion caused by various denominations. Overprotective and authoritarian parenting, cultural and socio-environmental factors may contribute to the development of dependent personality. Psychological epigenetic factors, such as early socio-emotional trauma could <imprint>> on neuronal circuits in prefronto-limbic regions that are essential for emotional behaviour.We also focus on the interrelations between dependent personality, domestic violence and addictions. The objective for the clinician is to propose a restoration of self-esteem and therapeutic strategies focused on autonomy.

Measuring IPDE-SQ personality disorder prevalence in pre-sentence and early-stage prison populations, with sub-type estimates

Understanding the prevalence and type of personality disorder within prison systems allows for the effective targeting of resources to implement strategies to alleviate symptoms, manage behaviour and attempt to reduce re-offending. This study aimed to determine the prevalence of personality disorder (PD) traits within a local urban high-turnover adult male prison with a remand/recently sentenced population in London, UK. The International Personality Disorder Examination - Screening Questionnaire (IPDE-SQ) self-administered questionnaire (ICD-10 version) was completed by 283 prisoners (42% completion rate). 77% of respondents reached the threshold for one or more PDs. The most common PD types were Paranoid PD (44.5%), Anankastic PD (40.3%), Schizoid PD (35%) and Dissocial PD (25.8%). These results confirm and extend existing knowledge regarding the prevalence of PD in prison populations into a high-turnover, urban, remand population. The stark comparison with community samples indicates that a more equitable standard of service delivery within the criminal justice system, focussing on preventive and early intervention services, is now required.

Homicidal behaviour among people with avoidant, dependent and obsessive-compulsive (cluster C) personality disorder

BACKGROUND

Despite a growing forensic psychiatry literature, no previous study has examined in detail homicidal behaviour among offenders with cluster C personality disorders - the avoidant, dependent or obsessional personality disorders.

AIMS

This study aims to compare homicide offenders with cluster C personality disorders with those with other personality disorders on criminal history, offender-victim relationship and post-offence reaction variables.

METHODS

The sample was drawn from all Finnish homicide cases of 1996-2004 for whom a forensic psychiatric evaluation had been conducted. Data were extracted from forensic psychiatric and crime reports.

RESULTS

In a nationwide sample of 593 homicide offenders, 21 had at least one cluster C personality disorder. These offenders had significantly shorter criminal histories than the others. Offender-victim relationship did not differ between the groups, but confession to the crime and feelings of remorse were more common among people with cluster C disorders. In addition, compared with other personality disorder clusters, co-morbid depression was more common.

CONCLUSIONS

Cluster C personality disorders are rare, but not nonexistent, among homicide offenders. Observed differences in their backgrounds and post-offence behaviours indicate that they may have special needs.

[Determination of psychological types of completed suicides based on the content analysis of suicide notes]

INTRODUCTION

Coherently classifying the numerous information gathered by suicide research may contribute to defining the major points of this research topic, furthermore the gathered data becomes more easy to handle. Similarly, the suicide classes help a deeper understanding.

METHOD

Examinees committed fatal suicide were investigated using content analysis. The obtained emotional and cognitive contents were classified by cluster algorithms.

RESULTS

Having analysed suicide notes of patients completed suicide we could distinguish 5 different suicidal motives: dependent; remorse-lead - perfectionist; physically suffering - seeking for greater autonomy; aggressive-narcissistic; masochist- revenge seeking.

CONCLUSION

The types reveal which personality traits and motives are the most definitive risk factors of committed suicide. Our results are affirmed by other typologies and research results.

A population-based longitudinal study of risk factors for suicide attempts in major depressive disorder

No longitudinal study has examined risk factors for future suicide attempts in major depressive disorder in a nationally representative sample. The objective of this study was to investigate baseline sociodemographic characteristics, comorbid mental disorders, specific depressive symptoms, and previous suicidal behavior as potential risk factors for suicide attempts at 3 years follow-up. Data came from the national epidemiologic survey on alcohol and related conditions (NESARC), a large nationally representative longitudinal survey of mental illness in adults [Wave 1 (2001-2002); Wave 2 (2004-2005) n=34,653]. Logistic regression examined associations between risk factors present at Wave 1 and suicide attempts at Wave 2 (n=169) among individuals with major depressive disorder at baseline assessment (n=6004). Risk factors for incident suicide attempts at Wave 2 (n=63) were identified among those with major depressive disorder at Wave 1 and no lifetime history of suicide attempts (n=5170). Results revealed specific comorbid anxiety, personality, and substance use disorders to be associated with incident suicide attempts at Wave 2. Comorbid borderline personality disorder was strongly associated with suicide attempts in all models. Several comorbid disorders were strongly associated with suicide attempts at Wave 2 even after adjusting for previous suicidal behavior, notably posttraumatic stress disorder (adjusted odds ratio (AOR)=2.20; 95% confidence interval (95% CI) 1.27-3.83) and dependent personality disorder (AOR=4.43; 95% CI 1.93-10.18). These findings suggest that mental illness comorbidity confers an increased risk of future suicide attempts in major depressive disorder that is not solely accounted for by past suicidal behavior.

[Clinical personality trait differences in the maintenance of abstinence and in relapses in the treatment of smoking cessation]

Clinical personality trait differences in the maintenance of abstinence and in relapses in the treatment of smoking cessation. The aim of this study is to describe and compare personality characteristics of participants who quit smoking voluntarily by means of group treatment. The assessment instrument used was the Millon Clinical Multiaxial Inventory (MCMI). It was administered to a sample of 105 persons in Málaga (Spain) in The Spanish Cancer Association (Asociación Española Contra el Cáncer). The analysis consisted of comparing two sample groups: abstinence and relapse. The results revealed a higher rate of avoidant, masochistic and negativistic clinical personality traits in the relapse group. However, people with dependent personality traits maintained abstinence. There were also differences, in the direction of more relapses, in schizotypal and borderline personality disorders. This suggests that certain personality traits could be risk factors for relapse, whereas others increase the probability of success in the process of smoking cessation.

Bond disorders of a patient with asthma: a case study

The issue of treatment and providing preventive activities in bronchial asthma is still not fully investigated. Besides the medical aspect, psychiatrists and psychologists point to psychosomatic aspects, since psycho-social factors can evoke intensification of asthma symptoms, and also become the consequences of that disease. Previous psychosomatic investigations show that chronic illness makes the patients reveal extended dependence on others. Patients may also tend to perceive other people as being responsible for their health problems. Such an attitude is usually caused by the disease process and the feeling of threat related to disease symptoms. In the present article I discuss the case of a patient with diagnosed bronchial asthma who was in the course of psychodynamic therapy. The aim of therapy was to help the patient in an interpersonal sphere and, when a therapeutic alliance is already established, to support individualization and separation in his previously disordered process of development, and finally to support the process of recovery. The case presented below is one of many others, when patients with chronic diseases, including bronchial asthma, apply for therapy. The adult patients usually complain about discomfort in social situations, sometimes about difficulties with keeping work that they have just got, or, like in this case, about bond disorders which reveal as intrusiveness and adhesiveness.

Two behavioural indicators of dependency and the Five-Factor Model of personality

Residence with parents and unemployment during studies were chosen as the two behavioural indicators of dependency among 601 undergraduate students. Students completed a demographic questionnaire, Costa and McCrae's (1992) NEO-FFI and Beck, Davis, and Freeman's (1990) Typical Beliefs of DPD. Unemployed students, living with their parents, were found to be significantly more dependent, neurotic and agreeable and less extraverted, conscientious and open than employed students who did not reside with their parents. Residing with parents during one's studies was the strongest predictor of dependency and neuroticism, followed by unemployment. Unemployed male students, who resided with their parents, were the most dependent, neurotic and agreeable and the least open, extraverted and conscientious group. The relationship between dependency and the Big Five is also discussed.

When what I wish makes me worse ... to make coherence flexible

This paper describes a psychotherapeutic constructivist intervention oriented to the resolution of implicative dilemmas, in order to promote personal change. It presents a clinical case study of a client with depression and with some dependent and obsessive functioning. The Repertory Grid Technique was administered along with symptom assessment (SCL-90-R) both at beginning and end of the psychotherapeutic process. Exploring themes emerged from Repgrid, several narratives, experiential and metaphoric strategies were used in order to explore and reconstruct meanings associated with the five implicative dilemmas found. The therapeutic process succeeds at solving dilemmas as found in the post-therapy assessment. This resolution was accompanied by symptom reduction. In conclusion, the utility of implicative dilemmas as a marker to understand the therapeutic impasse and dysfunctional system coherence is discussed, as well as the efficacy of the strategies used in this clinical case concerning its adaptation to working with implicative dilemmas that prevent therapeutic process.

The quality of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition dependent personality disorder prototype

OBJECTIVE

The aim of this study was to investigate the quality of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition dependent personality disorder (DPD) prototype with special reference to possible bidimensionality.

METHOD

The sample included 1078 patients, 81% (n = 875) had 1 or more personality disorders. The proportion of patients with DPD was 11.3% (n = 122). Frequency distribution, chi2, correlations, reliability statistics, exploratory and confirmatory factor analyses were performed.

RESULTS

Of the DPD criteria, criterion 3 showed a higher correlation with avoidant personality disorder than with DPD itself, whereas criterion 5 was weakly correlated with DPD, findings being confirmed by an exploratory factor analysis and a low internal consistency of all DPD criteria. An a priori hypothesized 2-factor model was confirmed by the confirmatory factor analysis.

CONCLUSIONS

These results indicate a moderate to low quality of the DPD construct. The main objection is that DPD is based too heavily on a bidimensional model of perceived incompetence and dysfunctional attachment. Items should be revised, in particular, items 3 and 5.

Characteristic interpersonal behavior in dependent and avoidant personality disorder can be observed within very short interaction sequences

We present a behavior observation study of interpersonal behavior in 96 female subjects, who had been screened for the presence of dependent, avoidant, narcissistic and histrionic personality disorder features. Each subject took part in three short role-plays, taken from assertiveness training. Afterwards, both the subject and her role-play partner judged, how assertive the subject had been. Although observation time was very short, dependent and avoidant subjects could be easily identified from their overly submissive behavior in the role-plays. Histrionic and narcissistic subjects did not show distinctive interpersonal behavior. Contrary to a common belief, higher scores on some personality disorder (PD) scales were positively related to cross-situational variability of behavior. Results are discussed with regard to their implications for clinical diagnostics, therapy and the methodology of personality disorder research in general.

Dependency and suicidality in addictive disorders

Excessive interpersonal dependency has been described in depression and addictive disorders. Moreover, excessive dependency and suicidality are linked in psychiatric subjects, but their relationships have not been studied in specific addictions. Separate samples of female anorectic patients (n=150), female bulimic patients (n=95), male (n=150) or female (n=68) alcoholics, male (n=94) or female (n=54) drug abusers and non-psychiatric control subjects (n=683) were included in the study. On the basis of a structured interview, suicidal ideations, number of previous suicide attempts and diagnoses of dependent personality disorder (DSM-IV) were collected, and the subjects completed the Interpersonal Dependency Inventory and the Beck Depression Inventory. Logistic regression analysis revealed that excessive dependency and notably dependent personality disorder increased the likelihood of suicidal ideation or suicide attempts with a range of 2.65 to 9.42 in bulimic patients, female alcoholics and male drug abusers. Excessive dependency in specific addictive disorders as well as in male non-psychiatric subjects could constitute a risk factor for suicide. This hypothesis must be confirmed using prospective studies.

Maladaptive dependency traits in men

In this article, the authors intend to bring to the reader's attention the negative impact men's maladaptive dependency traits can have on their lives and methods by which these traits can be addressed in treatment. A review of the literature about dependence, dependency traits and dependent personality disorder is presented including the influence of early childhood experiences, gender differences, comorbidity with Axis I disorders, and assessment and treatment. Several clinical case examples highlighting the subtle expression of dependency traits in men are presented and discussed.

The dimensionality of dependent personality disorder

The criteria for dependent personality disorder (DPD) in DSM-IV appear to fall into two categories: dependent and attachment behaviors. The relevance of this division was evaluated in a sample of 182 patients admitted to a national Norwegian psychiatric hospital. Principal Components Analysis of all items belonging to the most frequent personality diagnoses revealed six components. The items for DPD formed two components, labeled attachment/abandonment and dependency/incompetence. Two criteria for borderline personality disorder also loaded on the attachment/abandonment component, while six criteria for avoidant personality disorder loaded on the dependency/incompetence component. Early Maladaptive Schemas of abandonment and failure correlated significantly higher with the attachment/abandonment component than with the dependency/incompetence component.

Beliefs in personality disorders: a test with the Personality Disorder Belief Questionnaire

The hypothesis that each personality disorder (PD) is characterized by a specific set of beliefs was tested in a sample of 643 subjects, including non-patient controls, axis-I and axis-II patients, diagnosed with SCID-I and -II interviews. Beliefs of six PDs (avoidant, dependent, obsessive-compulsive, paranoid, histrionic, borderline) were assessed with the Personality Disorder Belief Questionnaire (PDBQ). Factor analyses supported the existence of six hypothesized sets of beliefs. Structural equation modeling (SEM) supported the hypothesis that each PD is characterized by a specific set of beliefs. Path coefficients were however in the medium range, suggesting that PDs are not solely determined by beliefs. Nevertheless, empirically derived cutoff scores of the six belief subscales were reasonably successful in classifying subjects, percentages ranging form 51% to 83%. It appeared that there was a monotonical increase in scores on each belief subscale from non-patient controls, to patients without any PD, to patients with PDs (other than the pertinent PD), to patients with the pertinent PD. This suggests that PD-related beliefs are at least partly associated with (personality) psychopathology in general. Another explanation is that many patients' position on the underlying dimensions is not high enough to lead to a DSM PD diagnosis, but high enough to lead to an elevated belief score.

Patterns of personality disorders in women with chronic eating disorders

The aim of this study was to describe patterns of personality disorders (PDs) in women with chronic eating disorders (EDs). An index group of nineteen women who have had EDs for an average of 8.5 years was compared with a control group of same-aged women from the general population. At the time of the study the index group received treatment at a tertiary treatment center in Stockholm. The PDs were assessed using the DSM-IV part of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). In the index group, eighteen of nineteen fulfilled the criteria for one or more PD. The number of PD diagnoses for each women ranged from zero (n = 1) to eight (n = 2) with a median of three. Among the controls, only one woman fulfilled the criteria for one or more PD. The most prevalent disorders in the index group were Borderline, Avoidant, and Obsessive-Compulsive. The index group had significantly higher DIP-Q dimensional scores than the controls in the Paranoid, Schizoid, Schizotypal, Borderline, Histrionic, Avoidant, and Dependent scales. Although the assessment of PD symptoms was limited to self-reports, the high prevalence of PD diagnoses and PD symptoms most probably reflects the severe psychiatric impairments in patients suffering from chronic ED.

[Flight into the imaginary world and dependence: personality trait or opportunist defence mechanism in the transsexual]

While analysing the psychological functioning of sex reassignment candidates, it appeared that they frequently use the mechanism which consist in taking refuge in passivity and fantasies so that they can avoid displeasing situations, responsibilities and decisions making. This unconscious process, identified by Exner in the Rorschach as the Snow-White Syndrome seems to take place in a specific way regarding the real situation faced by the sex reassignment candidates: the achievement of their aim (the sex reassignment) actually depends on the medical crew (doctors, psychologists, surgeons). We wondered if this fact consisted in a stylistic component, that is to say a stable feature of transsexuals' personality or in an opportunist defence. The dependence on the third, executor and decision-maker could be seen either as the indication of this feature being a favourable condition to the construction of the transsexual Issue or a consequence the transsexual's real situation. The hypothesis of the situational use of this process is studied by comparing the frequency of the Snow-White Syndrome during the moment before giving the surgical response with its appearance frequency after the sex reassignment. The individuals' retest (7MF/7FM) after the operation brings favourable arguments to the second interpretation since the process stops being used as soon as the passive dependence position doesn't exist anymore (the Snow-White Syndrome disappears in 70% of cases). So, as the goals are reached (the medico-surgical transformation materialising the desire), the flight in fantasies and passivity is not necessary anymore and the dependence on contributors disappears. During the psychological follow-up, attention should be paid to this psychic impact of anatomical reality so that it favours an earliest access to autonomy the transsexual is able to prove. In regard of a psychological view (in opposition with a surgical view), this autonomy could be researched before the body transformation, validating the "Real Life Test" experience.

Predictors of pain catastrophizing in women with rheumatoid arthritis

Catastrophizing has been conceptualized as an appraisal, a cognitive distortion, and a coping mechanism in the psychosocial literature. Regardless of its conceptualization, catastrophizing has been associated with negative psychological and physical outcomes in numerous studies, including our intervention study with 90 women with rheumatoid arthritis. Because of catastrophizing's robust relationship with negative outcomes, predictors of catastrophizing as a pain coping behavior were investigated in this sample, using data collected from two points in time before the intervention. Using Lazarus and Folkman's stress and coping theoretical framework to guide the analyses, variables with a proximal relationship to catastrophizing in the framework were examined for significant associations with pain catastrophizing using correlational analyses. Subsequent stepwise regression involving all variables from Time 1 with significant associations resulted in a model that explained 63% of the variance in Time 2 pain catastrophizing scores. The four predictors in this model were dispositional pessimism, passive pain coping, venting (as a pain coping behavior), and arthritis helplessness. Potential clinical implications related to these predictors are also discussed. Knowledge about predictors of catastrophizing may enhance efforts to address this maladaptive pattern through educational and therapeutic approaches.

Interpersonal variability in dependent personality

The interpersonal circumplex (IPC) was recommended as a personality trait dimensional model with good potential to identify the phenomenological scope of personality disorders whose core dysfunction involves maladaptive expression of interpersonal traits. The IPC was then applied to the reconceptualization of dependent personality and dependent personality disorder. In Study 1, Pincus and Gurtman's (1995) three interpersonal vectors of dependency were validated via factor analyses conducted on two large samples (N = 921; N = 472) and a reliable self-report measure, the 3 Vector Dependency Inventory (3VDI) was constructed. In Study 2, two samples (N = 103; N = 122) of individuals identified as predominantly endorsing submissive dependence, exploitable dependence, or love dependence, or who were low in aspects of dependency were compared via ANOVA and chi-square analyses on parental representations, adult attachment styles, loneliness, and pathological attachment. Submissive dependence was associated with higher scores on maladaptive constructs (fearful attachment, pathological attachment, and loneliness) and was also associated with lower parental affiliation and higher maternal control. Love dependence was associated with lower scores on maladaptive constructs and higher scores on secure attachment and parental affiliation. Variability in dependent phenomenology was related to its three component traits. Multiple perspectives on integrating love dependence, exploitable dependence, and submissive dependence into a reconceptualization of dependent personality disorder were articulated.

Assumptions in borderline personality disorder: specificity, stability and relationship with etiological factors

The specificity and stability of a set of assumptions hypothesized to be characteristic of Borderline Personality Disorder (BPD) was investigated. BPD patients (n = 16) were compared to cluster-C personality disorder patients (n = 12) and to normal controls (n = 15). All subjects were female and diagnosed with SCID-I and -II. Subjects rated a short version of the Personality Disorder Beliefs Questionnaire (PDBQ), with six sets of 20 assumptions each, hypothesized to be characteristic of avoidant, dependent, obsessive-compulsive, paranoid, histrionic and borderline personality disorder. The BPD assumptions (Cronbach alpha = 0.95) proved to be the most specific to BPD patients. Subjects rated the shortened PDBQ again after viewing an emotional video fragment one week later. Despite increased negative emotions, the PDBQ ratings remained relatively stable. Confirming the cognitive hypothesis, regression analyses indicated that the BPD assumptions mediate the relationship between self-reported etiological factors from childhood (sexual abuse and emotional/physical abuse) and BPD pathology assessed with the SCID-II. It is suggested that a set of assumptions is characteristic of BPD, and is relatively stable despite the instability of the behaviour of people diagnosed as having BPD.

[Comparative study of the relationship between alexithymia and affective dependence on 60 alcoholics and 57 control subjects]

Several authors have shown that alexithymia characterizes patients suffering from substance abuses. Moreover emotional and perceptual dependencies have also been described in these disorders. The aim of this study is to test two hypotheses: First that the emotional components of alexithymia and dependency were linked in alcoholics and secondly that the cognitive components of these two dimensions were also linked in these subjects. Two groups were recruited: 60 inpatients filled out the DSM IV criteria for alcohol dependence and 57 healthy subjects were the controls. All the subjects completed the following rating scales: the twenty items Toronto Alexithymia Scale (TAS-20), the Interpersonal Dependency Inventory (IDI), the Beck Depression Inventory, the Embedded Figures Test (EFT). Partial correlations (r Bravais Pearson), using BDI score as constant, were calculated. In normals the Feelings subscale of the TAS-20 correlated with the Lack of social self confidence subscale of the IDI (r = 0.43, p < 0.0018) and in alcoholics the Cognitive factor of the TAS-20 correlated with the Lack of social self confidence subscale (r = 0.41, p < 0.0018). Moreover in alcoholics, the cognitive factor of the TAS-20 correlated significantly with the EFT score (r = -0.35, p < 0.003).

CONCLUSION

In alcoholics the cognitive component of alexithymia and the perceptual component of dependency were linked, independently of an associated depression. A particular cognitive style characterized by externality and field dependence could characterized dependent alcoholics.

[Dependence disorders in psychopathology]

Research concerning the psychopathological aspects of dependence implicates a wide range of behaviors reassembled under the term of "dependence behaviors": sexual, medical, alcoholic and tobacco dependencies. Speech samples of dependent subjects show that encountering the object of dependence (product, element, ...) introduces a particular form of organized psychological processes. According to several authors, psychopathological dependence can be attributed to: early personality development; failures in the separation-individuation processes; disorders in mother-infant interactions; and a deficit in the psychological functioning of the subjects. For psychopathology, the dependence cannot be reduced to physiological dependence on the product but is understood rather in terms of a complex process indicative of either specific or non-specific suffering which is addressed by abused substance that represents a solution--the effects of which constitute the addictive process. Understanding this process requires an analysis of the psychopathological dependence from a triple meta-psychological viewpoint (topographical, dynamic, economic). Such analysis allows for a psychoanalytical theoretical interpretation of dependence based on three models: pleasure, narcissism and stress reduction. At the same time, the analysis extends the examination of psychopathological dependence towards issues concerning the body. Such body issues are critically placed between the biological and the psychological processes.

[Suicidal behavior and borderline states in adolescence. Thoughts on a dependence problem]

The process of self destruction in suicidal behavior for borderline patients seems to have a breaking function of filiation which has to live in mortify parental desire- or non-desire, both of them reflect a lack of investment. It tries to reach a part of the adolescent's body, figuration place of filial alienation, neither in a death desire, but in will rebirth.

Implicit and self-attributed dependency needs in dependent and histrionic personality disorders

Theorists speculate that dependent personality disorder (DPD) and histrionic personality disorder (HPD) are both associated with high levels of implicit (i.e., unconscious) dependency needs but speculate that only DPD is associated with high levels of self-attributed (i.e., conscious) dependency needs. To test this hypothesis, 444 undergraduates (236 women and 208 men) completed the Personality Diagnostic Questionnaire-Revised (PDQ-R), along with widely used measures of implicit dependency needs (the Rorschach Oral Dependency Scale; ROD), and self-attributed dependency needs (the Interpersonal Dependency Inventory; IDI). Correlational analyses and comparisons of IDI and ROD scores in participants scoring above and below the PDQ-R DPD and HPD thresholds supported theorists' speculations regarding implicit and self-attributed dependency needs in DPD and HPD. Implications of these results are discussed, and suggestions for future studies are offered.

Therapy-resistant periodontitis. Psychosocial characteristics

This study investigated the perspective of a stress system disorder in the pathogenesis of therapy-resistant periodontitis. The goal was to find indications that the stress-behaviour-immune system model holds as an explanatory model for the understanding of periodontal disease. 2 patient-groups were compared: one group classified as responding well to periodontal treatment (responsive-group, R-group, n=11); the other group was classified as responding less well to treatment (non-responsive-group, NR-group, n=11). Somatic and psychological factors were described as obtained by interviews and psychological testings. These findings were related to clinical data documented during the treatment of the patients. An exact logistic multivariate regression analysis was performed on a model based on variables selected by bivariate analysis (variable versus group). The results indicated that the NR-group patients displayed indications of more psychosocial strain and a more passive-dependent personality. The R-group patients displayed a more rigid personality and possibly a less stressful psychosocial situation in the past. The report highlights the possible contribution of stress factors in the context of therapy resistant periodontal disease, and the results seem to be understandable within the context of a stress system disorder perspective.

[Is the anxious patient dependent?]

To answer the question: is the anxious a dependant person, it is necessary to define to what extend behaviour depends on pathology. The difficulty in answering this question relies on the fact that these two phenomenons interact with each other. The comorbidity analysis allows a descriptive point of view. It shows a higher incidence of these troubles when occurring together, compared to a general population. Nevertheless, the comorbidity approach does not give any information on the nature of the links between anxiety and dependence. The causality models depend on the theory they use. Furthermore, unity between anxiety and dependence disorders does not exist; it is then certainly a mistake to consider their link in a unique way. Three main hypothesis are usually used. The neurobiology point of view supposes a link between brain structures, neurofunctioning, anxiety and dependence disorders. Some authors suggest a general addictive propensity of brain functioning, especially in cases of anxiety disorders. Lastly, the psychopathological analysis can be useful in the understanding of dependence behaviour in case of anxiety.

Peer assessment of personality traits and pathology in female college students

Assessment procedures for personality disorders (PDs) typically rely on self-reports, even though some people with PDs may be unable to view themselves realistically or are unwilling to report socially undesirable traits. Close associates may provide important information regarding the presence of PD traits. Peer nomination is a reliable and valid assessment procedure that can be adapted to the study of PDs for research purposes. This study focused on characteristic features that define narcissistic, dependent, and obsessive-compulsive PDs using information collected from both self and others in a nonclinical sample of women. It was designed to identify specific areas of agreement and discrepancy between self-report and peer assessment in the measurement of characteristic features of these disorders.

Depathologizing dependency

For nearly a century psychologists, psychiatrists, and other mental health professionals have emphasized the maladaptive, problematic aspects of dependent personality traits. In this article, I review theoretical frameworks that have played a key role in pathologizing dependency, and then describe empirical findings which indicate that dependency is not simply a flaw or deficit in functioning but is also associated with a variety of healthy, adaptive traits, and behaviors. The theoretical, empirical, and clinical implications of depathologizing dependency are discussed.

Depression and dependency: distinct or overlapping constructs?

BACKGROUND

Previous research has found a significant positive relationship between dependency and level of depression. The aim of the present study, using factor analysis method, is to test the hypothesis that dependency and depression constitute distinct dimensions.

METHODS

In a sample of 202 university students, a correlation matrix comprising items from both the Interpersonal Dependency Inventory and the abridged form of the Beck Depression Inventory was analysed using a principal components analysis followed by an orthogonal varimax rotation.

RESULTS

Evidence for a four-factor solution was found with almost no overlap of the significant factor loadings for the items from each scale, and with the factors corresponding closely with their respective construct.

CONCLUSION

The findings support the view that depression and dependency constitute different constructs.

LIMITATION

The results must be confirmed on clinical and heterogeneous nonclinical samples.

CLINICAL RELEVANCE

The independency between depression and dependency could lead to different therapeutic strategies notably in 'socially dependent' type of depression.

Separation anxiety in adulthood: a phenomenological investigation

Separation anxiety disorder is well recognized as a juvenile psychiatric disorder, but it appears to be rarely diagnosed in adulthood. Drawing on our clinical impressions and a review of the relevant literature, we sought to investigate whether separation anxiety symptoms could be identified in adulthood. Forty-four subjects recruited by a media campaign were administered a semistructured interview and a self-report checklist for adult separation anxiety (ASA) symptoms, as well as the Separation Anxiety Symptom Inventory (SASI), a retrospective measure of early separation anxiety symptoms. Diagnoses of major depressive disorder (MDD), panic disorder (PD), agoraphobia (Ag), and dependent personality disorder were made using the SCID-P and SCID-II. Thirty-six subjects met criteria for a putative diagnosis of ASA based on a global clinical rating and/or endorsement of DSM-IV-derived criteria. Although most subjects dated the separation anxiety symptoms to their juvenile years, it was notable that one third reported the first onset of separation anxiety symptoms in adulthood. Although comorbid lifetime anxiety or depressive disorders were common, the majority of subjects reported that the separation anxiety symptoms predated other axis I disorders. Only six subjects (17%) were diagnosed with dependent personality disorder. Although limited by the method of sampling, this preliminary study suggests the need to examine more systematically whether a form of separation anxiety disorder may occur in adulthood.

Precursors to masochistic and dependent character development

Due to the extreme states of masochism, dependency, and narcissistic rage that these patients experience, the treatment must be attuned to the inevitable periods of regression and primitive defense. The patient feels compelled to be a servant to the object, yet is furious at this less than equal status. The alternating states of idealizing the object in a masochistic fashion, the anger at the lack of self importance, and the desperate hope for soothing from that object create an externally focused character structure, which generally leads to a pattern of acting out, the lack of internal linking processes, and a scarcity of interpersonal skills that foster mutuality. A fundamental lack of self soothing leads to a perpetual search and craving for the soothing talents of the object. It is often unconsciously believed that compliance and servitude will bring about this gift of soothing from the object. Hans Loewald (1962) had described internalization as a process whereby the child reaches out to take back from the environment what has been removed from him in an ever-increasing manner since his birth. For the forgotten hero, this theory is definitely true. Not only is the treatment of this type of patient one of gradual internalization of new internal object relationships and the working through of the older more pathological ones, but it is a true understanding between patient and analyst of the original nontolerable removal of the uniqueness of the self via reality and/or fantasy states. When this situation is focused upon and worked with, the taking back from the environment can occur in a spirit devoid of former states of envy, hate, resentment, and wild craving that were formally protected and disguised in a facade of dependent masochism. The patient has essentially experienced or perceived his parents, usually the mother, as not providing a soothing function or a proper fit for his developing ego. The patient has then gone about constructing various methods to compensate for this lack. The analyst is often experienced as not providing an adequate soothing function, but this emptiness is warded off from conscious expression with a compromise formation of dependent, masochistic, or narcissistic methods of relating. This style of compromise hides any envy, hunger, or rage and keeps alive the hopes of being rewarded with soothing. The patients expects to be used as a waste disposal unit and believes that this dumping by the object into him is the longed-for love. Ideally, interpretations focus upon the hunger for the soothing function of the object and the drive to obtain it at any cost. The patient will fiercely resist because he believes that in giving up his masochism and dependency, he would expose his envy and narcissistic injury. This patient believes he would then lose any hope of ever receiving the soothing function due to the fantasized destruction of the source of that soothing, his beloved object.

Antisocial personality by proxy: the Norton-Sims syndrome

An antisocial personality disorder by proxy is defined by a proposed set of diagnostic criteria and a general description of proxy and perpetrator characteristics. Subtypes, dynamics, and features of this proposed disorder are described, and five-factor personality model (Costa & Widiger, 1994) loadings for the proxy and perpetrator are hypothesized. The relationship to abuse trauma and the five-factor personality model are discussed along with implications and suggestions for future research.

Excessive dependency and depression: is the relationship specific?

Excessive dependency has been hypothesized to be both a risk factor and a complication of depression. The purpose of this study was to test the specificity of the relationship between DSM-III-R dependent personality disorder (DPD) and depressive disorders. Two hundred subjects were independently administered the Structured Clinical Interview for DSM-III-R (SCID) and the Personality Disorder Examination (PDE) face-to-face by two experienced clinicians. Comorbidity of DPD and axis I disorders of five different types was examined. Dependent personality disorder was associated with mood disorders, both bipolar disorder and major depression, but was also associated with several anxiety disorders, bulimia, and nonaffective psychotic disorders. Dependent-personality disorder was associated with borderline, avoidant, schizotypal, obsessive-compulsive, narcissistic, and paranoid personality disorder made no significant additional contribution to the association between personality disorder and axis I disorder. These results suggest the DPD represents maladaptive traits and behaviors that cut across a range of personality psychopathology and are related to a variety of types of psychological distress. Thus, a specific++ relationship od DPD to depression was not supported.

The dependent personality and interpersonal problems

At the core of the dependent personality disorder lies an excessive reliance on other people for support, direction, and nurturance. However, because of their interpersonal style, many patients high in dependency have difficulties establishing and maintaining close interpersonal relationships. The present study examined interpersonal problems related to the dependent personality disorder. The relationships between dependency and interpersonal problems were examined in 43 adult psychiatric inpatients and 66 nonpatient adults. All subjects were assessed for social functioning in terms of social behaviors typically displayed, density of their social networks, and subjective feelings of loneliness. Using correlations and multiple regression analyses, results showed that dependency was closely related to social behavior and quality of social networks for both psychiatric inpatients and nonpatient controls. Pearson correlations showed the dependent personality style was related to negative and disruptive interpersonal behaviors. Also, measures of social functioning were related to feelings of loneliness and depression. Finally, interpersonal dependency was strongly related to both depressive symptoms and depressive attitudes, especially in the psychiatric inpatients. The present findings demonstrate the importance of interpersonal dependency as related to interpersonal problems.

Personality traits in social phobia, I: Comparisons with healthy controls

BACKGROUND

Patients with social phobia often describe a general interpersonal sensitivity and meet criteria for DSM-III-R avoidant personality disorder. This study addresses the question of whether patients with social phobia have characteristic abnormal personality traits.

METHOD

A questionnaire with 140 items for self-rating personality traits was constructed for the study. Ratings obtained from 63 patients with social phobia were compared with ratings from 58 healthy controls. Structured interviews were also conducted with the patients to establish whether their disorders met the criteria for the DSM-III-R avoidant and/or dependent personality disorders.

RESULTS

Ninety-one items on the questionnaire were rated significantly (p < .01) differently by the patients and the controls. These items were divided into two item-groups, one relating to avoidant social behavior (subdivided by factor analysis into six factors) and another relating to more general depressive-anxious traits (five factors). The total scores had a normal distribution among the patients. With the 95th percentile of the controls as the cutoff point, only 22% of the patients had a total score within normal limits on avoidant social behavior. Avoidant personality disorder was diagnosed in 60% of the patients.

CONCLUSION

The results support the hypothesis that patients with social phobia generally have characteristic abnormal personality traits, but lend no support to a division of the symptoms and traits into two separate diagnoses.

Active dependency

Although dependency has long been associated with passivity, weakness, and submissiveness, a review of the empirical literature reveals that, in certain situations and settings, dependent persons actually exhibit a variety of active, assertive behaviors. In this article, I: a) trace the historical roots of the dependency-passivity link; b) review empirical studies from developmental, social, and clinical psychology which indicate that, in certain circumstances, dependency is associated with active, assertive behavior on the part of the dependent person; c) offer an alternative conceptual model of dependency that accounts for the entire range of behaviors-both passive and active-that are exhibited by the dependent person; and d) discuss the diagnostic and therapeutic implications of this alternative conceptual model of dependency.

Interpersonal problem-solving skills training in the treatment of self-poisoning patients

The present study evaluated the effectiveness of interpersonal problem-solving skills training (IPSST) for the treatment of self-poisoning patients. Thirty-nine self-poisoning patients were assigned randomly either to IPSST or to a control treatment condition (a brief problem-oriented approach). Both conditions were equally effective in reducing the number of presenting problems and in reducing hopelessness levels. However, the IPSST condition was significantly more effective than the control condition as determined by other outcome measures (measures of interpersonal cognitive problem solving, self-rated personal problem-solving ability, perceived ability to cope with ongoing problems, and self-perception). Follow-up studies showed maintenance of IPSST treatment gains at 6 months and a greater reduction of repetition of self-poisoning in the IPSST group at 1 year posttreatment.

ABC of sleep disorders. Withdrawal from hypnotic drugs

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