Maladaptive Personality Functioning Research Articles

Mentalization based treatment for a broad range of personality disorders: a naturalistic study

BackgroundSeveral studies have observed that mentalization-based treatment (MBT) is an effective treatment for borderline personality disorder (BPD), but its effectiveness for other personality disorders (PDs) has hardly been examined. Additionally, the evidence supporting the claim that MBT improves mentalizing capacity is scarce. The present study examined whether (i) patients with a broad range of PDs enrolled in an MBT program would improve on several outcome measures (ii) mentalizing capacity would improve over time; (iii) patients with BPD would improve more than those with non-borderline PDs.MethodPersonality disorders, psychiatric symptoms, social functioning, maladaptive personality functioning and mentalizing capacity were measured in a group of individuals with various PDs (n = 46) that received MBT. Assessments were made at baseline and after 6, 12, and 18 months of treatment. The severity of psychiatric symptoms, measured using the Outcome Questionnaire 45, was the primary outcome variable.ResultsOverall, enrollment in the MBT program was associated with a decrease in psychiatric symptoms and an improvement of personality functioning, social functioning for a mixed group of PDs (all p’s ≤\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\le$$\\end{document} .01). Bigger effect sizes were observed for BPD patients (n = 25) than for patients with non-BPD (n = 21), but the difference failed to reach statistical significance (p = 0.06). A primary analysis showed that the decrease in psychiatric symptoms was significant in BPD patients (p = 0.01), not in non-BPD (p = 0.19) patients. However, a sufficiently powered secondary analysis with imputed data showed that non-BPD patients reported a significant decrease in psychiatric symptoms too (p = 0.01). Mentalizing capacity of the whole group improved over time (d = .68 on the Toronto Alexithymia Scale and 1.46 on the Social Cognition and Object Relations System).DiscussionThese results suggest that MBT coincides with symptomatic and functional improvement across a broad range of PDs and shows that MBT is associated with improvements in mentalizing capacity. As the study is not experimental in design, we cannot make causal claims.ConclusionMentalization-based treatment may be an effective treatment for patients with a broad range of PDs.Trial registrationThe study design was approved by the Leiden University Ethical Committee.

Feasibility of EMDR toward Personality Functioning in Older Adults with PTSD

ABSTRACT Objectives Severe posttraumatic stress disorder (PTSD) in older adults (≥60 years) has been found to be associated with maladaptive personality functioning and personality disorders (PD). Emerging evidence in adults supports that reprocessing adverse events with Eye Movement Desensitization and Reprocessing (EMDR) could improve personality functioning and reduce full PDdiagnosis. Methods A multicenterfeasibilitystudy in 24 older PTSD-patients receiving weekly EMDR-sessions for either 3, 6 or 9 months. A linear-mixed-model was used with personality functioning (SIPP-SF) as dependent variable and time, PTSD-severity (CAPS-5), and “othertreatment” as predictor variables. Secondary, pre- and posttreatment percentages were calculated for the PDspresence. Results Symptom changes over time showed a significant influence of CAPS-5 on SIPP-SF (b = −1.40, 95% CI=[−2.48 to −0.33], p = .012), no significant effect of time for total SIPP-SF, and a significant improvement of SIPP-SF “identityintegration”-scale over time (b = 9.20, 95% CI=[0.97–17.42], p = .029). There was a marginal significant effect of “othertreatment” (b = 8.42, 95% CI=[−0.30–17.13], p = .058). There was 31% full PDs-decrease. Conclusions Observed improvements in personality functioning from pre to post EMDRtreatment were explained by PTSD-severity. Identityintegration improved significantly over time. Results suggest that participants with “othertreatment” showed more severe baseline-pathology and thus lower personality functioning. Clinical implications EMDR, in addition to being a feasible treatment option for older adults with PTSD, improves personality functioning and reduces the presence of PDs over time.’

Personality traits and disorders in Alzheimer's disease.

The relationships between axis II personality disorders and the normative personality traits were explored in the context of current and pre-morbid personality assessment in Alzheimer's disease (AD). The study was conducted with four groups who were administered the NEO-FFI and the PDQ-4+, in the form of individual interview sessions. Current personality measure: consisting of 44 female participants (AD group) and, the control group, consisting of 80 female participants from the population at large. Pre-morbid personality measure: AD group informants (n=40); control group informants (n=42). The results are in line with the literature review and provide new research data. By factorial discriminant analysis, the current and pre-morbid personality variables that differentiate AD from control groups are identified. The personality traits variables are the best discriminators such as low agreeableness, low openness to experience, and high neuroticism, suggesting that the maladaptive personality functioning can be described extending the range of psychopathology to a dimensional approach. The study of personality variables seems to suggest, in their inclusion, the possibility to increase sensitivity toward an assessment in AD.

The Relationship between Affect Integration and Psychopathology in Patients with Personality Disorder: A Cross-Sectional Study.

Background and Objectives: Emotional dysfunction is considered a key component in personality disorders; however, only few studies have examined the relationship between the two. In this study, emotional dysfunction was operationalized through the Affect Integration Inventory, and the aim was to examine the relationships between the level of affect integration and the levels of symptom distress, interpersonal problems, and personality functioning in patients diagnosed with personality disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Materials and Methods: Within a hospital-based psychiatric outpatient setting, 87 patients with personality disorder referred for treatment were identified for assessment with the Affect Integration Inventory and other measures (e.g., the Symptom Checklist-90, Revised, the Inventory of Interpersonal Problems 64 circumplex version, and the Severity Indices of Personality Problems). Results: The analyses revealed that problems with affect integration were strongly and statistically significantly correlated with high levels of symptom distress, interpersonal problems, and maladaptive personality functioning. Additionally, low scores on the Affect Integration Inventory regarding discrete affects were associated with distinct and differentiated patterns of interpersonal problems. Conclusion: Taken together, emotional dysfunction, as measured by the Affect Integration Inventory, appeared to be a central component of the pathological self-organization associated with personality disorder. These findings have several implications for the understanding and psychotherapeutic treatment of personality pathology. Furthermore, they highlight the importance of considering the integration of discrete affects and their specific contributions in the conceptualization and treatment of emotional dysfunction in patients with personality disorders.

Assessment of Personality Functioning in Adolescence: Development of the Adolescent Personality Structure Questionnaire.

Adolescence is a crucial period for the development of personality and its dysfunctions. In this regard, it is essential to evaluate the nature and degree of maladaptive personality functioning. However, measures currently available present some limitations, mainly being adaptations from adult's tailored instruments and length. Moreover, no instrument considers the crucial dimensions related to body development and sexuality. This contribution presents data on the Adolescent Personality Structure Questionnaire (APS-Q) development, a self-report measure to capture core aspects of personality functioning in adolescence while being agile and reliable. On two large samples of adolescents (total N = 1,664), we investigated the psychometric properties of the APS-Q. We explored its factor structure and construct and incremental validity in the first sample, testing specific associations with existing measures of severity of personality pathology, maladaptive personality traits, and psychological distress. In the second sample, we confirmed its factor structure, assessing gender and age invariance. Overall, our findings support the APS-Q's validity as a reliable and useful measure to assess personality functioning. Moreover, the APS-Q highlighted developmentally vital dimensions such as self-functioning (encompassing mental and bodily changes and considering the dimension of sexuality), interpersonal functioning (discriminating the dimensions of family and peers), and emotion regulation.

Childhood trauma, attachment and psychopathology: A correlation network approach

Consistent evidence supports the view that childhood trauma is linked with insecure attachment styles and psychopathology. However, it is a matter of debate how different forms of child maltreatment may relate with dimensions of anxiety and avoidance in attachment relationships and may foster specific configurations of clinical symptoms. Accordingly, examining the associations between childhood trauma, insecure attachment and psychopathology from a correlation network perspective may serve to fill a relevant gap in the literature. Three-hundred fifty-two adults aged between 18 and 73 years old (M= 32.70; SD = 11.72) completed measures on child maltreatment, attachment styles and psychopathology. A regularized partial correlation network was estimated to examine the relationships between the three constructs. The network showed 101 out of 190 nonzero correlations linking childhood traumatic experiences, anxious and avoidant attachment dimensions, and clinical symptoms. The analysis of the network showed that being exposed to emotional abuse and emotional neglect increased the risk of being exposed to other types of childhood trauma, such as physical abuse. Anxious attachment was more strongly linked to child maltreatment and psychopathology than avoidant attachment. Suicidal ideation and maladaptive personality functioning were the clinical symptoms most strongly connected with the other variables in the network. These findings might be relevant for the assessment and treatment of individuals who display clinical problems related to insecure attachment and early relational trauma.

The relationship between maladaptive personality functioning and problematic technology use in adolescence: A cluster analysis approach.

In the last two decades, scientific research has explored the problematic use of internet, videogames and mobile phones. However, there is still little consistent knowledge regarding the co-occurrence of problematic technology use and the role of maladaptive personality characteristics in adolescence. The present study aimed to investigate adolescents' styles of technology use with a cluster analysis approach focusing on personality functioning. The sample comprised 408 Italian adolescents (46.3% males) aged 11 to 18years (M age =13.80; SD=2.08). Data were collected using the Internet Addiction Test, the Videogame Dependency Scale, the Test of Mobile-Phone Dependence Brief Form and the Personality Inventory for DSM5 Brief Form. Results provided a four-cluster solution based on the co-occurrence of problematic technology use. The four clusters were labeled as follows: cluster 1: "Above average internet and mobile-phone use"; cluster 2: "Below average technology use"; cluster 3: "Above average videogame use"; and cluster 4: "Problematic technology use." Analyses on demographic variables (e.g., gender and age) demonstrated significant differences between the four groups. Adolescents with high levels of problematic technology use reported greater overall personality dysfunction than the other three groups. This finding supported our hypothesis on maladaptive personality functioning in adolescents at risk for addiction. Finally, the Antagonism domain played a specific role in differentiating the severity of adolescents' involvement in technology use. Further studies are needed to confirm our findings and to plan preventive interventions as well as therapeutic treatments.

Severity Indices of Personality Problems–Short Form in Old-Age Psychiatry: Reliability and Validity

The Severity Indices of Personality Problems (SIPP; Verheul et al., 2008) is a popular self-report questionnaire that measures severity of maladaptive personality functioning. Two studies demonstrated the utility of the short form (SIPP–SF) among older adults but validation in clinical settings is lacking. Therefore, we examined the psychometric properties of the SIPP–SF in a large sample of older adult Dutch outpatients (N = 124; age range = 60–85 years, M = 69.8, SD = 5.3). The SIPP–SF domains showed good to excellent internal reliability (Cronbach’s α = .75–.91) and effectively discriminated between participants with and without a personality disorder, as assessed with the Structured Clinical Interview for DSM–IV Axis II Personality Disorders (SCID–II). Convergent validity of the SIPP–SF was examined with instruments for measuring personality pathology among older adults (Informant Personality questionnaire [HAP]; Gerontological Personality Disorders Scale [GPS]). The GPS generally correlated with the SIPP–SF domains in expected directions, with small to large effect sizes. For the HAP, only 1 scale correlated with all SIPP–SF domains. No associations were found between the SIPP–SF and psychiatric symptomatology as measured by the Brief Symptom Inventory (BSI). The SIPP–SF appears to be a promising instrument for assessing maladaptive personality functioning among older adult outpatients.

The mediating role of identity disturbance in the relationship between emotion dysregulation, executive function deficits, and maladaptive personality traits

Difficulties in emotion regulation, executive function, and identity are central concerns associated with maladaptive personality functioning. However, no prior research has looked at the shared influence of these variables, and the central role of identity disturbance. The aim of this study was therefore to address the gaps in the current literature regarding the relationship between emotion dysregulation, executive dysfunction, and identity disturbance in individuals presenting with maladaptive personality traits. Structural equation modelling was used to analyse the mediating effect of identity disturbance on the relationship between both emotion dysregulation and executive dysfunction with maladaptive personality traits, among 212 university students aged 18–25. Identity disturbance partially mediated the relationship between emotion dysregulation and maladaptive personality traits, and fully mediated the relationship between executive dysfunction and maladaptive personality traits. Our results suggest that identity disturbance is a central construct involved in the manifestation of maladaptive personality traits. Whilst emotion dysregulation maintains an influence on the development of maladaptive personality traits, identity disturbance explains part of this relationship, as well as the relationship between executive dysfunction and maladaptive personality traits. Implications of these findings are discussed.

Maladaptive Personality Functioning and Psychopathological Symptoms in Problematic Video Game Players: A Person-Centered Approach.

BackgroundA need exists to increase our understanding of the association between maladaptive personality traits, psychopathological symptoms, game preference, and different types of video game use. In the present study, we used a person-centered approach to identify different subtypes of video game players and we explored how they differ in personality profiles, clinical symptoms, and video game usage.MethodsWe assessed problematic gaming via the nine-item Internet Gaming Disorder Scale and self-reported screen time playing video games in a sample of 366 adolescents and young adult gamers. Participants also completed measures on maladaptive personality domains (Personality Inventory for DSM-5 Brief Form), alexithymia (Toronto Alexithymia Scale—20 items), and psychopathological symptoms (DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure) and reported which genre of video games they preferred.ResultsUsing a person-centered, cluster-analytic approach, we identified four clusters of video game players (Occasional, Passionate, Preoccupied, and Disordered) presenting peculiar combinations of problematic gaming scores and time spent online playing video games. Non-problematic gamers (Occasional and Passionate) represented the majority of the sample (62.3% of the participants). Highly involved gamers who exhibited excessive screen time playing video games (Disordered gamers) presented the highest level of maladaptive personality traits and psychopathological symptoms, and were characterized by the greatest use of Multiplayer Online Battle Arena (MOBA) games.ConclusionThese results have clinical implications on suggesting the importance to determining whether or not problematic gaming activities reflect a dysfunctional emotion-focused coping strategy to avoid inner unpleasant emotional or a more generally compromised emotional and social functioning.

Profiling psychopathology of patients reporting early childhood trauma and emotional neglect: Support for a two-dimensional model?

Profiling patients who report early childhood trauma and emotional neglect may be useful for treatment planning. This study attempts to quantify a two-dimensional "trauma-neglect model" (Draijer, 2003) proposed to distinguish clinical profiles in terms of trauma-related, dissociative, and personality pathology. A sample of patients referred to a trauma program (n = 49) and a personality disorders program (n = 101) was extensively assessed. Cluster analysis was used to discriminate patients in terms of "psychiatric disease burden," based on symptom severity scores, type of disorder, and level of maladaptive personality functioning. Clusters that differed in psychiatric disease burden were mapped in the trauma-neglect space and their positions were evaluated. We found three clusters and labeled them as "mildly impaired" (26% of patients), "moderately impaired" (43% of patients), and "severely impaired" (31% of patients). The mean scores on trauma and neglect for the mild and severe groups differed significantly. These findings indicate that further investigation of the validity of the model, which may be used to plan treatment, is useful. Patients experiencing a wide range of trauma-related disorders, dissociative disorders (DD), and personality disorders (PD), combined with a high level of psychiatric symptoms and a maladaptive style of personality functioning, report a range of traumatic experiences in combination with a lack of maternal care, and can be profiled as "severely impaired." (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Severity of Personality Pathology: A Risk Factor for Concurrent Substance Use Disorders in Alcohol Use Disorder

Objective: Co-occurrence of substance use disorders (CO-substance use disorders) among individuals with alcohol use disorder (AUD) is largely recognized as a critical clinical issue. However, the specific clinical variables involved are still unclear. The recent findings are controversial in pointing out the unique contribution of both impulsivity and emotion dysregulation on CO-substance use disorders. Furthermore, the co-variation between AUD and other substance use disorders includes different aspects of maladaptive personality functioning (i.e., overall severity and specific features). Therefore, this study aims at clarifying the role of impulsivity, emotional dysregulation, and severity of personality pathology on CO-substance use disorders among treatment-seeking individuals with AUD. Methods: One hundred ninety-three treatment-seeking individuals with AUD (DSM-IV-TR) were consecutively recruited. Impulsivity (Barratt Impulsiveness Scale [BIS-11]), emotional dysregulation (Difficulties in Emotion Regulation Scale [DERS]), and personality pathology (Structured Clinical Interview for DSM-IV Axis II Personality Disorder [SCID-II]) were assessed after a 2-week detoxification period. The analyses were based on several stepwise forward logistic regressions. The total score of BIS-11 and DERS together with the number of SCID-II criteria were considered, in following the order, as independent variables controlling for the comorbidity with other lifetime Axis I disorders. CO-substance use disorders was the dependent variable (i.e., any CO-substance use disorders, benzodiazepine and cannabis/cocaine use disorders). Results: The number of SCID-II criteria was the only significant predictor of overall CO-substance use disorders, odds ratio (OR) = 1.16; 95% confidence interval (CI) [1.07, 1.26], p < .01, and cannabis/cocaine use disorders, OR = 1.19; 95% CI [1.08, 1.31], p < .01. On the contrary, DERS total score was the most robust predictor of benzodiazepine use disorder, OR = 1.02; 95% CI [1.01, 1.04], p < .01, albeit the severity of maladaptive personality functioning was also significantly associated with this disorder, OR = 1.09; 95% CI [1.00, 1.18], p < .05. Conclusions: The severity of maladaptive personality pathology represents one of the main aspects involved in CO-substance use disorders among individuals with AUD. This dimension predicts the CO-substance use disorders above and beyond specific personality dimensions and other psychiatric conditions. Therefore, personality functioning should be precisely assessed and personality pathology should be addressed in the framework of AUD treatments for promoting effective long-term outcomes.

The Unfabulous Four: Maladaptive Personality Functioning, Insecure Attachment, Dissociative Experiences, and Problematic Internet Use Among Young Adults

Even though positive associations among problematic Internet use (PIU), maladaptive personality traits, insecure attachment styles, and dissociation have been frequently observed in research, a need exists to examine the interrelationships among these factors in young adults. Two hundred fifty-three young adults (52% females) aged between 18 and 25 years old completed a sociodemographic form and measures on PIU, maladaptive personality traits, dissociative experiences, and adult attachment styles. They also reported how much time they usually spent online. A hierarchical multiple regression analysis showed that male gender, increased time spent online, negative affectivity, an avoidant attachment style, and dissociative symptoms of depersonalization/derealization were strongly associated with PIU scores in the sample. Our findings suggest that an excessive time spent online may combine with maladaptive personality features, insecure attachment dispositions, and difficulties in processing bodily experiences in generating PIU among young adults.

Trauma-Related Dissociation Is Linked With Maladaptive Personality Functioning.

Background: Extensive research has demonstrated the positive associations among the exposure to traumatic experiences, the levels of dissociation, and the severity of psychiatric symptoms in adults. However, it has been hypothesized in clinical literature that an excessive activation of the dissociative processes following multiple traumatic experiences may jeopardize the psychological and behavioral functioning of the individuals, fostering higher levels of maladaptive personality functioning.Methods: The study involved 322 adult volunteers from Italy. Participants completed measures on traumatic experiences, dissociation, and maladaptive personality traits.Results: The number of traumatic experiences reported by participants were positively associated with dissociation scores and maladaptive personality scores. Mediation analyses showed that dissociation acted as a partial mediator in the relationship between traumatic experiences and overall maladaptive personality functioning. Regression curve analyses showed that the positive association between maladaptive personality functioning and dissociation was stronger among participants with higher exposure to traumatic experiences.Conclusion: Exposure to multiple traumatic experiences may increase the risk for an excessive activation of the dissociative processes, which in turn may generate severe impairments in multiple domains of personality functioning.

Development and Validation of a Self-Report Measure of Mentalizing: The Reflective Functioning Questionnaire.

Reflective functioning or mentalizing is the capacity to interpret both the self and others in terms of internal mental states such as feelings, wishes, goals, desires, and attitudes. This paper is part of a series of papers outlining the development and psychometric features of a new self-report measure, the Reflective Functioning Questionnaire (RFQ), designed to provide an easy to administer self-report measure of mentalizing. We describe the development and initial validation of the RFQ in three studies. Study 1 focuses on the development of the RFQ, its factor structure and construct validity in a sample of patients with Borderline Personality Disorder (BPD) and Eating Disorder (ED) (n = 108) and normal controls (n = 295). Study 2 aims to replicate these findings in a fresh sample of 129 patients with personality disorder and 281 normal controls. Study 3 addresses the relationship between the RFQ, parental reflective functioning and infant attachment status as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. In both Study 1 and 2, confirmatory factor analyses yielded two factors assessing Certainty (RFQ_C) and Uncertainty (RFQ_U) about the mental states of self and others. These two factors were relatively distinct, invariant across clinical and non-clinical samples, had satisfactory internal consistency and test–retest stability, and were largely unrelated to demographic features. The scales discriminated between patients and controls, and were significantly and in theoretically predicted ways correlated with measures of empathy, mindfulness and perspective-taking, and with both self-reported and clinician-reported measures of borderline personality features and other indices of maladaptive personality functioning. Furthermore, the RFQ scales were associated with levels of parental reflective functioning, which in turn predicted infant attachment status in the SSP. Overall, this study lends preliminary support for the RFQ as a screening measure of reflective functioning. Further research is needed, however, to investigate in more detail the psychometric qualities of the RFQ.

Personality Disorders in Brazilian Homeless Compared with Non-Psychiatric and Psychiatric Patients

Personality disorders are regarded as conditions that involve a maladaptive personality functioning. Homelessness is a worldly debated phenomenon. The present study aimed to understand the situation of homelessness related to the health sector, instead of considering it only as a social or economic problem. Research was conducted with three different groups, male and female, living in a Metropolitan area of Southeast Brazil, the first composed of 71 homeless people; the second, 74 psychiatric patients; and the third, 250 college students that completed the Personality Disorders Dimensional Inventory (IDTP). A logit regression model and ROC curve were used to analyse data. Results showed that homeless people scored higher in all dimensions, especially Antisocial and Schizotypal, compared with the other groups. Although the number of participants was reduced to only one part of the country, as well as the correlational design preventing clearer causal inferences, the results of this research call the attention for the need of new investigations to homeless people’s mental health, aiming to focus on public health policies that could deal with the problem.

Convergent and Discriminant Validity of the Five Factor Form

The current study tests the convergent and discriminant validity of a modified version of the Five Factor Model Rating Form (FFMRF), a one-page, brief measure of the five-factor model. The Five Factor Form (FFF) explicitly identifies maladaptive variants for both poles of each of the 30 facets of the FFMRF. The purpose of the current study was to test empirically whether this modified version still provides a valid assessment of the FFM, as well as to compare its validity as a measure of the FFM to other brief FFM measures. Two independent samples of 510 and 330 community adults were sampled, one third of whom had a history of some form of mental health treatment. The FFF was compared with three abbreviated and/or brief measures of the FFM (i.e., the FFMRF, the Ten Item Personality Inventory, and the Big Five Inventory), a more extended measure (i.e., International Personality Item Pool-NEO), an alternative measure of general personality (i.e., the HEXACO-Personality Inventory-Revised), and a measure of maladaptive personality functioning (i.e., the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, 5th edition). The results of the current study demonstrated convergent and discriminant validity, even at the single-item facet level.

Maladaptively High and Low Openness: The Case for Experiential Permeability

The domain of Openness within the Five-Factor Model (FFM) has received inconsistent support as a source for maladaptive personality functioning, at least when the latter is confined to the disorders of personality included within the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, ). However, an advantage of the FFM relative to the DSM-IV-TR is that the former was developed to provide a reasonably comprehensive description of general personality structure. Rather than suggest that the FFM is inadequate because the DSM-IV-TR lacks much representation of Openness, it might be just as reasonable to suggest that the DSM-IV-TR is inadequate because it lacks an adequate representation of maladaptive variants of both high and low Openness. This article discusses the development and validation of a measure of these maladaptive variants, the Experiential Permeability Inventory.

Treatment Duration and Premature Termination of Psychotherapy in Personality Disorders

Little is known about predictors of treatment duration and premature termination of psychotherapy. Sociodemographic variables, descriptive DSM-IV psychiatric diagnoses, general symptom severity, and psychodynamic personality functioning were assessed in 148 inpatients with personality disorders who were receiving psychotherapy. Psychodynamic personality functioning was assessed using the Developmental Profile (DP). Predictive performance and incremental value over and beyond demographics and descriptive diagnoses were determined. In contrast to DSM-IV diagnoses and symptom severity, psychodynamic variables and the level of personality functioning significantly predicted treatment duration and premature treatment termination. Longer treatment duration was predicted by adaptive DP levels of personality functioning, whereas shorter treatment duration was associated with maladaptive personality functioning (primitive DP levels, including fragmentation and self-centeredness). DP variables independently explained 6% of the variance. In contrast to DSM-IV diagnoses and general symptom severity, psychodynamic personality variables significantly predicted treatment duration and premature discharge. These findings support the relevance of psycho-dynamic assessments in clinical practice, the DSM-5 proposals for the definition of personality functioning, and the predictive validity of the DP.

Assessment of identity development and identity diffusion in adolescence - Theoretical basis and psychometric properties of the self-report questionnaire AIDA.

BackgroundIn the continuing revision of Diagnostic and Statistical Manual (DSM-V) “identity” is integrated as a central diagnostic criterion for personality disorders (self-related personality functioning). According to Kernberg, identity diffusion is one of the core elements of borderline personality organization. As there is no elaborated self-rating inventory to assess identity development in healthy and disturbed adolescents, we developed the AIDA (Assessment of Identity Development in Adolescence) questionnaire to assess this complex dimension, varying from “Identity Integration” to “Identity Diffusion”, in a broad and substructured way and evaluated its psychometric properties in a mixed school and clinical sample.MethodsTest construction was deductive, referring to psychodynamic as well as social-cognitive theories, and led to a special item pool, with consideration for clarity and ease of comprehension. Participants were 305 students aged 12–18 attending a public school and 52 adolescent psychiatric inpatients and outpatients with diagnoses of personality disorders (N = 20) or other mental disorders (N = 32). Convergent validity was evaluated by covariations with personality development (JTCI 12–18 R scales), criterion validity by differences in identity development (AIDA scales) between patients and controls.ResultsAIDA showed excellent total score (Diffusion: α = .94), scale (Discontinuity: α = .86; Incoherence: α = .92) and subscale (α = .73-.86) reliabilities. High levels of Discontinuity and Incoherence were associated with low levels in Self Directedness, an indicator of maladaptive personality functioning. Both AIDA scales were significantly different between PD-patients and controls with remarkable effect sizes (d) of 2.17 and 1.94 standard deviations.ConclusionAIDA is a reliable and valid instrument to assess normal and disturbed identity in adolescents. Studies for further validation and for obtaining population norms are in progress and may provide insight in the relevant aspects of identity development in differentiating specific psychopathology and therapeutic focus and outcome.