Karolinska Psychodynamic Profile Research Articles

When Ejaculation Becomes the Goal in Itself: A Psychodynamic Approach to Delayed Ejaculation.

There are a group of men with delayed ejaculation (DE) where the etiology as well as the consequences of the dysfunction are unclear. The aim of the present study was to explore, from a psychodynamic perspective, personality traits among men seeking treatment due to DE. During a 2.5-year period, a consecutive series of 14 men with DE were seeking help at Karolinska University hospital, Sweden. Full medical history and physical examination, sexological case-history and psychological assessments were performed by physicians and a psychotherapist. The results found all patients to be healthy. Mean age was 34 years (range 20–43 years). No other sexual dysfunction occurred. With one exception, they were sexually active. The psychological assessment (The Karolinska Psychodynamic Profile; KAPP) found patients to have difficulties in areas of dependency and separation, control and impulse control, regression in the service of the ego, coping with aggressive affects, alexithymic traits, sexual function, and satisfaction. The results add a deeper understanding of personality traits among healthy patients with DE, which may be a tool for the case history, and offer new treatment strategies. We suggest that DE can be the physical manifestation of some specific personality difficulties, and thus, ejaculation becomes the goal in itself and not the climax of an enjoyable adventure.

Personality and Psychopathology in Patients With Mixed Sensory-Motor Functional Neurological Disorder (Conversion Disorder): A Pilot Study.

The purpose of this pilot study was to explore differences in the level of personality functioning, symptom severity, and personality pathology in patients with mixed sensory-motor functional neurological disorder (conversion disorder). Individuals with psychogenic nonepileptic seizures were not included. We recruited 15 patients, mean age of 33.5 years (SD, 11.4 years), 13 females and 2 males, from an outpatient clinic for psychotherapeutic treatment. We assessed the patients using the Structured Clinical Interview for DSM-4 Axis II Personality Disorders, the SCL-90-R, the Karolinska Psychodynamic Profile, and the Defense Style Questionnaire. We were able to distinguish two levels of difficulty in relation to personality functioning as distinct subgroups: 1) "neurotic" with less severe or moderate personality psychopathology and 2) "borderline" with severe personality psychopathology. Furthermore, we concluded that all patients showed severe deficits in personality functioning. The study points out the clinical relevance of identifying personality functioning as part of an assessment in the preparation of a treatment strategy.

Relationships, Emotions, and Defenses Among Patients with Substance Use Disorders, Assessed with Karolinska Psychodynamic Profile: Possibilities to use Intensive Short-Term Dynamic Psychotherapy in Substance Abuse Treatment

ABSTRACTSubstance use disorders (SUDs) are connected to emotional and relational difficulties. Intensive Short-Term Dynamic Psychotherapy (ISTDP) aims at supporting emotion regulation and relational capacity through confronting the patient’s defenses. The authors assessed relational capacity, emotion regulation, and defenses in nine patients with severe SUD and a history of childhood maltreatment, using the semistructured method Karolinska Psychodynamic Profile. All participants had difficulties in handling interpersonal dependence and separations. Functioning in other areas varied. ISTDP could be useful in substance abuse treatment. Thorough assessment before starting ISTDP is however recommended so that treatment is planned according to the patients’ level of functioning.

Another way to think about psychological change: experiential vs. incremental

The traditional pre-post treatment difference reflects an incremental notion of change, where a quantity of some psychological function is added to (or subtracted from) a pretreatment quantity. This study presents a complementary, experiential notion of change. Rather than a difference, change is a feeling or experience of having changed, a feeling that one is different than before. Based on a post-treatment interview the Change after Psychotherapy (CHAP) is a method to quantify/rate such ‘differentness’ in terms of how extensively or radically the patient feels having changed. A pre-post quasi-experimental study (N = 49) comparing the CHAP with ratings on the Global Assessment of Functioning, the Karolinska Psychodynamic Profile and the Comprehensive Psychopathological Rating Scale-Self-Affective is reported. The results showed the CHAP to be a reliable, valid and sensitive way to assess an experiential kind of CHAP.

Psychodynamic profile and reflective functioning in patients with bulimia nervosa

ObjectiveThe aim of this study was to examine the general psychological functioning of patients suffering from bulimia nervosa (BN) using the Karolinska Psychodynamic Profile (KAPP). Furthermore, KAPP data and data from the Reflective Functioning scale (RF), measuring the ability to mentalize, were combined in order to examine differences in alexithymia, impulse control and affect regulation in patients with high or low RF. MethodSeventy patients with BN were interviewed with both the KAPP and the Adult Attachment Interview (AAI) from which RF is coded. Differences in KAPP scores of patients with high or low RF were analyzed. ResultsMost of the patients with BN were found to have a personality structure within the normal or neurotic range (n=50 of 70). BN patients with a high RF had significantly lower scores on KAPP's alexithymia scale than patients with a low RF score, demonstrating that poor mentalizing is related to alexithymia. Concurrently, patients with high RF showed problems with impulse control and coping with aggressive affects according to KAPP scores. ConclusionAlthough BN patients with high RF showed good capacities for describing their mental states, they still had difficulties regulating the emotions and impulses related to these states. Significant outcomeAmong patients suffering from BN, patients with high RF were significantly less alexithymic than low RF patients. LimitationsThe findings of this study are limited by the relatively small numbers of participants especially in the RF subgroups, posing a danger of not finding as significant existing differences in character pathology between high and low RF groups.

Karolinska Psychodynamic Profile for Sexual Disorders: KAPP-SD. A proposal for a psychodynamic rating scale for sexual disorders

Objective: Our first objective in this paper was to review the literature on psychodynamic rating scales of sexual disorders. Our second objective, based on the findings from our review, was to develop a psychodynamic rating scale for people with sexual disorders: the KAPP-SD. Method: We developed the KAPP-SD by modifying an existing psychodynamic rating scale, which assesses stable modes of mental functioning and character traits, the Karolinska Psychodynamic Profile (KAPP). We removed items 13 and 14 of the KAPP and replaced them with three other items—sexual fantasies, conceptions and role of gender identity, and conceptions and role of sexual orientation. These items are part of the assessment of an individual's sexuality and are used to evaluate a person with a sexual disorder psychodynamically. Results: The KAPP-SD, a modified version of the KAPP, can be found in the Appendix. Conclusion: We developed the KAPP-SD in order to help sex therapists make a rigorous psychodynamic evaluation of persons with sexual disorders, which would give information on the prognosis and on the type of treatment to offer.

Operationalizing the Psychodynamic Diagnostic Manual: A preliminary study of the Psychodiagnostic Chart

The Psychodiagnostic Chart (PDC) operationalizes the Psychodynamic Diagnostic Manual (PDM) Adult section. The authors collected 104 PDC cases from 15 psychologists who are experts with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). They found very good construct validity when the PDC was compared to MMPI-2, the Karolinska Psychodynamic Profile (KAPP), and the Operationalized Psychodynamic Diagnosis (OPD) Psychic Structure/Mental Functioning Scales. They found very good reliability for the 73 cases with a 2-week test-retest of the PDC. Additionally, 61 psychologists were recruited from listservs and asked to use the PDC on a recent client; 84% rated Level of Personality Organization as "helpful-very helpful" in understanding their patients. There was also similar support for the Personality Patterns or Disorders and Mental Functioning dimensions. In comparison, only 31% rated the ICD or DSM symptoms as "helpful-very helpful" in understanding their patients. The PDC may be used for diagnoses, treatment formulations, progress reports, and outcome assessment, as well as for empirical research on the PDM.

Similarities and differences in borderline and organic personality disorder

IntroductionPrevious research has shown that brain injury patients with Organic Personality Disorder (OPD) may display “borderline” traits due to prefrontal damage, and their personality structure may be unstable and close to a borderline personality organisation. They may have few general neuropsychological dysfunctions but specific executive deficits. Similar deficits have been found in patients with Borderline Personality Disorder (BPD). The objective of this study was to identify differences and similarities between the neuropsychological and personality profiles of BPD and OPD patients.MethodsTwenty BPD patients and 24 OPD patients were assessed with the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), the Karolinska Psychodynamic Profile (KAPP), and a comprehensive neuropsychological test battery.ResultsVery few neuropsychological differences were found between the two patient groups. However, the verbal fluency, verbal intelligence, verbal memory, and immediate auditory memory/attention of the BPD patients were significantly poorer than the OPD patients'. The KAPP profiles of the BPD patients showed significantly poorer functioning in three areas: frustration tolerance, the body as a factor of self-esteem, and overall personality organisation.ConclusionsThese results support our clinical experience and expectations concerning the severity of symptoms of both patient groups. We suggest considering in depth assessments of both neuropsychological and personality-related problems for each of these patients in order to inform treatment.

Four problems with psychodynamic assessment of drug abusers

The purpose of the present paper was to discuss problems in psychodynamic personality assessment of drug abusers diagnosed with personality disorders (PDs). Four problems related to interview assessments, such as SCID (Structured Clinical Interview for DSM) and KAPP (Karolinska Psychodynamic Profile) were discussed. The problems were: (1) the drug interferes with personality, (2) the duration of detoxification before drug abusers are tested and interviewed is usually insufficient, (3) drug abusers generally suffer from “dysfunctional personality resources” such as deficiency in memory, incapacity for psychological reflections, and lack of verbal and preverbal affect differentiation (alexithymia), (4) the conditions drug abusers must accept to receive clinical care, activate manipulative behaviour and latent defence mechanisms during interviews. Projective tests were also discussed as personality assessment. These methods were explored in relation to Freud's topographical model.

OBJECT RELATION QUALITY, ALEXITHYMIA, AND DEFENSE MECHANISMS OF DRUG ABUSERS WITH ANTISOCIAL PERSONALITY DISORDER

The purpose was to investigate, in a sample of drug abusers, whether subscales in the KAPP (Karolinska Psychodynamic Profile, Weinryb, 1992) interview and defense mechanisms explored by the DMTm (Defense Mechanism Technique modified) could differentiate between DSM-III-R clusters and personality disorders (PDs). Forty-seven (47) subjects out of the 84 injecting drug abusers (56%) recruited from a detoxification hospital ward in Sweden had a primary antisocial PD (ASPD) with a comorbid second DSM-III-R PD diagnosis. Pathology was significant on the KAPP subscales of“Dependency and separation,” “Alexithymic traits,” “Normopathic traits,”“Coping with aggressive affects,” and “Sexual satisfaction” in relation to cluster B (dramatic). All subscales were predominant in patients with ASPD/narcissistic PD, who showed the defense mechanism marked denial. The two latter subscales were related to patients with ASPD/borderline PD, who showed the defense of introaggression and the DMTm sign of disappearance of threat. Finally, some psychoanalytic constructs in KAPP and DMTm showed congruence.

Baseline personality characteristics of responders to 6-month psychotherapy in eating disorders: Preliminary data

The Karolinska Psychodynamic Profile (KAPP) was used for the assessment of the six-month outcome of Brief Adlerian Psychodynamic Psychotherapy (B-APP). Fifty-seven eating disordered women (28 with anorexia nervosa, 29 with bulimia nervosa), were included in the study. The sample was evaluated at baseline (time 0) and after six months (T6) with a clinical assessment and with Temperament and Character Inventory (TCI), Eating Disorder Inventory (EDI-2), State-Trait Anger Expression Inventory (STAXI), and KAPP. Based on symptomatologic improvement, two sub-groups were obtained: responders (66.6%) and non-responders (33.3%). Significantly higher baseline scores emerged in the responders group on Ineffectiveness and Impulsivity (EDI-2) and on Harm Avoidance (TCI). Several KAPP items and areas improved in both groups at T6. Multimodal treatment centered on B-APP lead to both a global clinical improvement and an improvement in several psychological and psychopathological features as assessed by EDI-2, STAXI and KAPP. The results suggest interesting clinical implications, though outcome predictors are quite weak.

Change After Long-Term Psychoanalytic Psychotherapy

Psychoanalytic psychotherapy in clinical practice is traditionally a long-term treatment conducted by well-trained psychotherapists. However, very few studies have been published that evaluate the effects of such treatment. To redress this lack of studies, 55 individuals selected for long-term psychoanalytic psychotherapy (average, 3 years) were invited to participate in a naturalistic study. The psychotherapists had a mean of 15 years of professional experience. The 36 patients who completed psychotherapy manifested a substantial reduction in symptomatic suffering and decreased levels of character pathology, as measured by the Karolinska Psychodynamic Profile (KAPP) and the Karolinska Scales of Personality. Generally, such changes were not found in the individuals who did not engage in treatment. In the therapy group, improvements were found on eight KAPP subscales defining different aspects of character: Intimacy and Reciprocity, Frustration Tolerance, Regression in the Service of the Ego, Coping with Aggressive Affects, Conceptions of Bodily Appearance and their Significance for Self-esteem, Sexual Function, Sexual Satisfaction, and Personality Organization. The results indicate that individuals who engaged in psychotherapy improved their capacity to handle crucial aspects of life and reduced their symptomatic suffering.

Unstable identity and prefrontal injury

Introduction. In neuropsychological research, “organic personality disorder”, lack of social insight, and executive dysfunctions have been identified in patients with prefrontal brain injury. The assessment of personality change has, in particular, been a methodological challenge in this field of research. The aim of the present pilot study was to examine personality aspects in patients with prefrontal brain injury from a neuropsychological as well as a psychodynamic point of view. Methods. A total of 13 adults with personality change as a manifest sequel after sudden onset brain injury were assessed with neuropsychological tests of executive functions, with the European Brain Injury Questionnaire (EBIQ), and with the Karolinska Psychodynamic Profile (KAPP), which to our knowledge has not previously been used as part of a neuropsychological assessment. The personality profiles of the brain‐injured patients were compared to the personality profile of a group of 65 brain‐healthy individuals. Results. The personality organisation of the prefrontally brain‐injured patients was significantly disturbed and close to a borderline personality organisation, as defined by the KAPP. Conclusions. The results of the pilot study suggest that prefrontal brain systems may support the integration of self‐functions and play a central role for inter‐personal relations. Future research regarding the relation between brain dysfunction, executive and cognitive deficit, and personality disorder needs to be carried out in larger samples to substantiate the hypothesis of a relationship between prefrontal brain systems and self‐functions.

Psychodynamic personality profile in first‐episode severe mental disorders

The aim of this study was to relate measures of psychoanalytically derived personality traits to descriptive diagnosis and psychopathology in severe mental disorders. Sixty-one consecutive first-episode patients with schizophrenia, bipolar disorder and severe major depression were interviewed. Personality traits were assessed with the Karolinska Psychodynamic Profile (KAPP) and compared with the DSM-IV diagnosis and symptom clusters derived from the BPRS. There were no marked differences in personality traits between the three diagnostic groups, between schizophrenia and affective disorders or between psychotic and non-psychotic illness. However, personality traits had significant associations with symptoms, especially with the emotional retardation cluster. Our findings do not support the hypothesis that severe mental disorders would differ from each other in terms of long-standing psychodynamic personality profiles. Certain dysfunctional personality traits may predict especially negative emotional symptoms and possibly also predispose a person to them.

Personality traits predicting long-term adjustment after surgery for ulcerative colitis.

Very few studies have examined the relationship between personality traits and long-term postoperative psychosocial adjustment. In a sample of 46 patients, we examined the relation between personality traits before pelvic pouch surgery for ulcerative colitis and psychosocial adjustment seven years postoperatively, controlling for the effects of surgical functional outcome. The Karolinska Psychodynamic Profile (KAPP) was used for personality assessment. Surgical functional outcome scales and the Psychosocial Adjustment to Illness Scale were also used. As assessed by the KAPP, poor frustration tolerance, long-standing preoperative problems in sexual functioning, perfectionistic body ideals, and lack of alexithymia predicted poorer postoperative long-term psychosocial adjustment in the areas of health concerns, sexuality, family relations, and psychological distress. Surgical functional outcome itself was a poor predictor of long-term adjustment. The results indicate that it may be beneficial to take personality factors into account in preoperative assessment.

Baseline personality functioning correlates with 6 month outcome in schizophrenia

Objective. – The assessment of outcome in schizophrenic patients should consider both the response to treatment and the recovery of social skills. The aim was to evaluate the outcome and related psychostructural and clinical factors in schizophrenic patients after they underwent 6 months of residential multimodal treatment. Method. – Fifty-two schizophrenic patients enrolled in a multimodal treatment program were included in the study. Symptomatology and social functioning were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Social and Occupational Functioning Assessment Scale (SOFAS). The Karolinska Psychodynamic Profile (KAPP) was used for the psychostructural evaluation. Results. – After 6 months there was a significant improvement in the global scores of BPRS, SOFAS, and some areas of KAPP. The personality (KAPP) and social-occupational functioning (SOFAS) at baseline (T0) correlated with the global score of BPRS at 6 months (T6); moreover, SOFAS at T6 correlated with BPRS and KAPP at T0 and with the illness duration. Conclusion. – The better the personality functioning in schizophrenic patients the better seems to be the response to treatment, with regard to symptoms as well as rehabilitation. Personality assessment might be useful for the individualisation of therapies, even within the context of a standardised program.

Anxiety, Aggression, and Body Ideal in Adult Atopic Dermatitis Patients

Background: Aggression and body ideal hold important implications for the anxiety level associated with atopic dermatitis (AD). Most studies of aggression in AD have relied on self-evaluation measures or case descriptions. Methods: This study investigates the relationship between anxiety and management of aggression and body ideal, using the Karolinska Psychodynamic Profile (KAPP), a semi-structured interview quantifying clinical behavior. In KAPP body ideal, consists of 3 subscales: Bodily appearance (BA), bodily functioning (BF), and body image (BI). Results: Thirty-one adult AD patients were compared on KAPP, trait anxiety (STAI), the anxiety index on the SCL-90, and skin condition (SCORAD). Aggression was significantly correlated with STAI (r = 0.42, p < 0.05) and SCL-90 (r = 0.48, p < 0.01). STAI, but not SCL-90, was correlated with BA (r = 0.39, p < 0.05), BF (r = 0.51, p < 0.01) and BI (r = 0.36, p < 0.05). A post hoc analysis suggested that the SCL-90 depression index rather than anxiety is associated with BI. There was no relationship between SCORAD and KAPP or SCORAD and anxiety level. Conclusion: It is concluded that aggression and body ideal are important indicators for managing anxiety in AD, and that KAPP is a relevant inventory in the assessment of AD.

Depressive disorders and personality variables in HIV positive and negative intravenous drug-users

Background: Only a few reports investigated the prevalence of depression in intravenous drug-users with HIV infection, including both asymptomatic and symptomatic subjects. In the same group, the association of depression and personality diagnoses was also poorly researched. Methods: A consecutive sample of intravenous drug-users was collected from patients admitted to an infectious disease clinic, another random sample was taken from out-patients attending a methadone maintenance treatment program. Subjects were first screened with the Hospital Anxiety and Depression Scale, and then all positive subjects were evaluated with the Composite International Diagnostic Interview. Depression was diagnosed according to DSM-IIIR. In-patients were also given a structured personality inventory (Karolinska Psychodynamic Profile). Results: HIV-positive patients had a high rate of depression (major depression 36.2%, dysthymic disorder 7.1%) when compared to HIV-negatives (15.7 and 3.9%, respectively). In-patients had the highest rate of depression, irrespective of HIV clinical staging. A personality disorder was diagnosed in 36% of the sample, but these subjects were no more significantly depressed. Limitations: Poor detection of depression by the admitting physician may have led to selective hospitalization of patients with both HIV and mood disorder. The composition of the sample may also be biased by the help-seeking behavior of HIV patients who are also depressed. Conclusion: Physicians treating AIDS patients should be alerted to the high rate of depression in clinical HIV illness, in order to identify and properly treat depression.

The core conflictual relationship theme (CCRT) and psychopathology in patients selected for dynamic psychotherapy

The present naturalistic study examined the relation between core interpersonal patterns measured by the Core Conflictual Relationship Theme (CCRT) method and psychopathology in 55 patients selected for long-term dynamic psychotherapy. Psychopathology was assessed by the DSM-III-R, symptom self-report, and the Karolinska Psychodynamic Profile (KAPP). Patients with different DSM-III-R diagnoses did not differ in their CCRTs abstracted from the Relationship Anecdote Paradigm interview. Furthermore, lack of flexibility (pervasiveness) in the use of different CCRT components was not associated with psychiatric symptoms. Only one significant correlation between character pathology and the CCRT was found: problems concerning the patients' experience of social significance were associated with more negative responses of other. Limitations of the CCRT method and the sample used are discussed. Die vorliegende naturalistische Studie prüfte den Zusammenhang zwischen interpesonalen Mustern - gemessen mit der ZBKT-Methode - und der Psychopathologie bei 55 Patienten, die für eine psychodynamische Langzeittherapie indiziert waren. Psychopathologie wurde mit dem DSM-III-R, Selbstbeschreibungen und dem Karolinska Psychodynamic Profile (KAPP) untersucht. Patienten mit verschiedenen DSM-III-R Diagnosen unterschieden sich nicht im Hinblick auf ihre ZBKT in einem Beziehungsinterview. Mangel an Flexibiltät bezüglich unterschiedlicher ZBKT-Komponenten stand nicht in Beziehung zu psychiatrischen Symptomen. Nur eine signifikante Korrelation zwischen Charakterpathologie und ZBKT lie ß sich nachweisen: Probleme der Patienten mit ihrer sozialen bedeutung standen in Beziehung zu negativeren Reaktionen von Objekten. Bergrenzungen der ZBKT-Methode und der Stichprobe werden diskutiert. Cette étude naturaliste examine la relation entre des patterns interpersonnels de base mesurés par la méthode du Thème Relationnel Conflictuel Central (CCRT) et la psychopathologie chez 55 patients sélectionnés pour une psychothérapie psychodynamique de longue durée. La psychopathologie a été évaluée selon DSM-III-R, par un auto-questionnaire de symptômes et par le Karolinska Profile Psychodynamique (KAPP). Les patients avec des diagnostics DSM-II-R différents n'ont pas montré de différence dans leur CCRT obtenu sur la base d'interviews RAP (Paradigme d'Anecdotes Relationnelles). Par ailleurs, le manque de flexibilité ('pervasiveness') dans l'emploi des différentes composantes du CCRT n'a pas été associé à des symptômes psychiatriques. Une seule corrélation significative entre pathologie de catarctèe et CCRT aété trouvée; une expérience de position sociale problématique a été associée à des réponses de l'autre plus négatives. Nous discutons des limitations de la méhode du CCRT et de l'échantillon. El presente estudio naturalístico examina la relación entre el núleo de pautas interpersonales medida por el método del Tema Nuclear Relacional Conflictivo (CCRT) y la psicopatología en cincuenta y cinco pacientes seleccionados para psicoterapia dinámica a largo plazo. La psicopatología se evaluó según el DSM-III-R, el informe auto-administrado de sintomas y el Perfil Psicodinámico de Karolinska (KAPP). Pacientes con diferentes diagnósticos según el DSM-III-R no difirieron en el CCRT abstraído de la entrevista Paradigma Anecdótico Relacional (Relationship Anecdote Paradigm). Más aun, la falta de flexibilidad ['pregnancia' ('pervasiveness')] en el uso de diferentes components del CCRT no estuvo asociada con síntomas psiquiátricos. Solo se encontró una correlación significativa entre la caracteropatía y el CCRT; los probelmas relacionados con la experiencia de significatividad social de los pacientes estuvo asociada con respuestas más negativas del otro. Se discuten las limitaciones del método del CCRT y de la muestra usada.

What patient characteristics make therapists recommend psychodynamic psychotherapy or other treatment forms?

In order to study factors that psychodynamic therapists considered to be important for recommendation of treatment, psychiatric diagnoses (DSM-III-R Axes I and II and the GAF) as well as character traits assessed by the Karolinska Psychodynamic Profile (KAPP) were retrospectively assessed in interview case-notes of patients applying for psychodynamic psychotherapy. Recommendation of psychotherapy was predicted by the absence of a personality disorder and high GAF scores, but not by the presence of a psychiatric syndrome. The KAPP differentiated between patients with and without disorders on Axis II, but not on Axis I. Patients who were recommended psychodynamic psychotherapy were healthier on all central KAPP variables compared to those who were recommended other treatments, and they were also characterized by predominantly neurotic personality organization, with inhibition as the most prominent defence.