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.
Highlights
The operationalize psychodynamic diagnosis 2 (OPD task force, 2006) is a multiaxial system combining the purely descriptive approach of the current classifications DSM-IV and ICD-10 with individualized, psychodynamic differentiation based on psychoanalytical principles
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)
Age ranged from 19 to 60 years. 27 (47.4%) participants (66.7% females) were diagnosed with PTSD according to the PDS, as compared to 29 (75 % females), who were not
Summary
The operationalize psychodynamic diagnosis 2 (OPD task force, 2006) is a multiaxial system combining the purely descriptive approach of the current classifications DSM-IV and ICD-10 with individualized, psychodynamic differentiation based on psychoanalytical principles. The OPD-2 axis I is governed by psychodynamic theory supposing that facets of personality structure, typical unconscious conflictual themes and relationship patterns would have an impact on the course of illness Based on these theoretical assumptions, the OPD-2 axis I take emotional, cognitive and behavioral resources into consideration, as it dedicates itself to the subjective appraisal of the burden and of the effects of an illness. The fourth factor ROP specifies health-related characteristics rooted in personality structure (such as experience of self-effectiveness, adaptive relationships, capacity to be on ones own or to distance oneself, emotional competencies and others), and the willingness to occupy oneself with a psycho-reactive genesis of complaints Another resource of interest for this factor is the availability of support from the social environment. The fifth factor IMP refers to the inner resistance against psychotherapy, such as poor motivation to identify and clarify the underlying psychosocial causes of health-related problems, and to the gratification which the individual receives through the illness [5]
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