Clinical Trauma-Correlates and the Motivation for Psychotherapy

Abstract

The Operationalized Psychodynamic Diagnosis OPD-2 is a multi-axial diagnostic system based on psychodynamic principles. Axis I (OPD-2 axis I), assessing “experience of illness and prerequisites for treatment”, contains the factors: 1) psychological orientation” (PSO), 2) “somatic orientation” (SMO), 3) “social orientation” (SCO), 4) “resources and openness” (ROP), 5) “impediments to therapy and secondary gain from illness” (IMP). The experience of illness and the prerequisites for treatment are linked to the subjective suffering, a construct modulated by depression, in theory and clinical practice, and to structure in a psychoanalytical sense. The corresponding structural functions are typically altered in trauma-correlates. This study examined the effects of posttraumatic stress disorder (PTSD), borderline criteria (BLC), dissociation and depression on the experience of illness and the prerequisites for treatment in 53 inpatients of a psychotherapeutic clinic using the OPD-2 axis I, the AMDP module dissociation (AMDP-dis), the posttraumatic distress scale (PDS), the SCID II and the Montgomery Asberg Depression Rating Scale (MADRS). Somatoform disorders were linked to SMO, whereas depression and PTSD were linked to PSO. Extracting the shared variances separated single dissociative symptoms from the other syndromes. Specific associations showed between the factors of OPD-2 axis I and dissociative, as well as non-dissociative syndromes. PSO was best predicted by amnesia, as opposed to the prediction of IMP by identity disturbances. These findings indicate a hierarchy of defences within the dissociative spectrum and a mediating function of some dissociative symptoms on the orientation towards therapy.