Operationalized Psychodynamic Diagnostics Research Articles

Exploring the associations between psychodynamic constructs and psychopathology: A network approach.

Psychodynamic therapy effectively reduces symptomatology by focusing on underlying (unconscious) processes instead of symptoms. Nevertheless, the exact interrelationship between psychodynamic constructs and psychopathology remains unclear. This study uses network analysis to explore these associations. We computed a cross-sectional partial correlation network between psychodynamic constructs (i.e., personality functioning, interpersonal relations, and active and passive modes of intrapsychic conflicts according to the Operationalized Psychodynamic Diagnostics [OPD] system) and psychopathology (i.e., depression and somatization) in a naturalistic sample of 341 adults registering for psychodynamic outpatient therapy. We estimated node centrality, node predictability, and bridge symptoms and used community detection analysis. Bootstrap methods were applied to assess network stability. Psychodynamic constructs and psychopathology resulted in separate but connected clusters. Personality functioning emerged as the most influential node in the network and was bridging the clusters. The network was found to be highly stable, allowing reliable interpretations. The results offer important insights on how psychodynamic constructs relate to psychopathology, which can be used to inform treatment approaches. The findings suggest that personality functioning may be an important intervention target. However, future research is needed to include a broader range of diagnoses. In addition, longitudinal studies may clarify the direction of causality.

Reliability and validity of the OPD-conflict-questionnaire in an inpatient treatment sample

Reliability and validity of the OPD-conflict-questionnaire in an inpatient treatment sample Objectives: Unconscious conflicts are a major part of psychodynamic diagnostics. Benecke et al. (2018) developed the OPD-conflict-questionnaire (OPD-CQ) to assess unconscious conflicts according to the Operationalized Psychodynamic Diagnostics (OPD) via self-report. We inspected its reliability and validity in a large inpatient sample with a focus on correlations with symptomatic burden, interpersonal problems, and structural level. Methods: N = 2083 patients completed questionnaires at the beginning of their inpatient stay in the Fachklinikum Tiefenbrunn between 2017 and 2020. We calculated internal consistencies of the OPD-CQ scales and (partial-)correlations of the OPD-CQ scales with different instruments. Results: Internal consistencies were only partly satisfying (for eight of 13 scales). We found significant (partial-)correlations of the conflicts with symptom severity and interpersonal problems which were in line with expectations. However, structural level correlated with more conflicts than we expected. Conclusions: Due to the low internal consistencies of some scales, we recommend a revision of the OPD-CQ. Still, the found correlations show the potential of the OPD-CQ as a screening instrument for patients in inpatient treatment.

Psychodynamic conflicts: Development of a questionnaire for the assessment by patients and their therapists

Psychodynamic conflicts: Development of a questionnaire for the assessment by patients and their therapists Abstract. The OPD-CA conflict questionnaire represents a means of recording modes of coping with unconscious conflicts according to the Operationalized Psychodynamic Diagnostics (OPD-CA) for patients and their therapists. To select the items for the conflict questionnaire, we combined the expert ratings and psychometric quality criteria using a sample of 427 adolescents (53.6 % patients) and 44 therapists. The short version contains 28 items, which include 7 intrapsychic conflicts and their active and passive coping modes (total ICC = .855; p < .001). We found expected differences between healthy and clinically abnormal adolescents with a higher level of conflicts among outpatients. A comparison of the therapist's version with two different methods (assessment according to the sheet in OPD-CA and the conflict questionnaire) produced consistent assessments of the same patient both in the expert assessment (total ICC = .861; p < .001) and from the point of view of 52 participants in two OPD-KJ training courses (total ICC = .825; p < .001).

Diagnostic work with the conflict axis of the OPD-CA: Empirical results on inpatients and outpatients

Diagnostic work with the conflict axis of the OPD-CA: Empirical results on inpatients and outpatients Abstract. In recent years, the Operationalized Psychodynamic Diagnostics (OPD-CA) is increasingly being used in child and adolescent psychiatry and psychotherapy. This article presents the conflict axis of the OPD-CA, which contains an operationalization of seven psychodynamic conflicts and the processing modes assigned to them. It describes empirical comparisons of the conflict axis ratings and the structure rating in a group of outpatient and inpatient children and adolescents (total N = 186, 12.7 years, 54 % female). The findings in the total sample show that diagnosis-specific gender differences are disappearing, and that male and female patients have largely similar intrapsychic development-impairing conflicts. Patients in inpatient treatment in a child and adolescent psychiatry institution, however, more often show a self-conflict and, as expected, have a lower structural level than patients of the same age in outpatient psychotherapy. The number of highly stressful events before the start of therapy is also significantly higher in this group, which may have contributed to the structural deficits. For outpatients, there is a strikingly higher level of guilt and identity conflicts. In both samples, the mode of processing the conflicts is largely passive. Based on these findings, possible implications for therapeutic practice are discussed.

The development and application of conflict-specific story completion tasks as part of OPD diagnostics in childhood

The development and application of conflict-specific story completion tasks as part of OPD diagnostics in childhood Abstract. The study combines use of the MacArthur Story Stem Battery (MSSB) with the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA-2). It describes the development and application of conflict-specific story completion tasks, which are meant to enable a systematic evaluation of the conflict axis and the structure axis of Age Group 2. It determines interrater reliability for the conflict axis and the structure axis and checks further exploratory correlations between conflict axis and structure axis using the SDQ (Strengths and Difficulties Questionnaire). The diagnostic method presented here enables a reliable evaluation of the conflict axis and the structure axis. Moreover, correlations occur between the OPD-CA-2 axes and the SDQ.

Psychodynamic psychiatry and neurobiology

The historical development of psychodynamic psychiatry and its core principles were focussed on in the perspective of current research, especially of neuroscientific research. The three-dimensional model of psychodynamic and neuro-psychodynamic psychiatry and spatiotemporal psychopathology are described and applied to depression and schizophrenia as clinical examples underlining the practical relevance of the neuro-psychodynamic approach for psychiatric treatment and psychotherapy. Operationalized psychodynamic diagnostics (OPD) is discussed as an "instrument to transfer psychodynamic constructs into neuroscience".

Связь жизнестойкости студентов с отношением к ним родителей

The authors focus on the controversial situation of a large number of theoretical and practical works on psychological aspects of education, the high importance of hardiness for productive life of individuals in modern society and the absence of works exploring how parents influence the formation of hardiness in their children. The paper presents results of the study of the relationship between hardiness in young male and female students and the features of their subjective childhood image of family and current attitudes of their parents. The sample of the study was 119 students (43 males and 76 females).Methodological support of the research included the following: Hardiness test (Hardiness Survey by S. Muddi, adapted by D.A. Leontiev); two scales of the BIV questionnaire (Biographisches Inventar zur Diagnose von Verhaltenstörungen) revealing the nature of childhood image of family; the Operationalized Psychodynamic Diagnostics technique assessing the key aspects of relationships. The results of the study showed that the level of hardiness in the subjects is closely related to the nature of their childhood images of family: the more positive the image is, the higher the hardiness. The relationship between hardiness and the current attitude of parents has both common and gender-specific trends. Parental care and high interest in preserving the child’s attachment impede the manifestation of hardiness in the young people. The gender specifics of those aspects of parental attitude that promote hardiness does not coincide with the generally accepted patterns.

Nonsuicidal self-injury in connection with the axes Structure and Relationship of the OPD-KJ-2 (Operationalized Psychodynamic Diagnostics in Childhood and Adolescence)

Nonsuicidal self-injury in connection with the axes Structure and Relationship of the OPD-KJ-2 (Operationalized Psychodynamic Diagnostics in Childhood and Adolescence) Abstract. This study investigates nonsuicidal self-injury (NSSV) in relation to psychological structure as well as inter- and intrapersonal relationships. The Structure and Relationship axes of the OPD-CA-2 (Operationalized Psychodynamic Diagnosis in Childhood and Adolescence) were used to record relationship dynamics and structural aspects; the MOUSI was applied for nonsuicidal self-injury. The sample included 40 adolescent psychiatric patients, most of whom were in inpatient care. A total of 20 adolescents with and 20 without NSSV were compared with regard to the Structure and Relationship axes. The two samples showed no differences on the Structure axis, whereas differences were found on the Relationship axis. Adolescents with NSSV, for example, were more likely to gently influence others and to react in interactive settings more openly toward their counterpart than adolescents without NSSV. In their relationship to themselves, the adolescents with NSSV were more often assessed as tormented and reproachful. Results indicate that the Relationship axis of the OPD-CA-2 can provide helpful information, so that this should be considered in psychotherapeutic measures for NSSV patients.

Changes in the scales "attachment" and "control" of the OPD-KJ "structure" axis for inpatients of a pediatric and adolescent psychiatric clinic

Changes in the scales "attachment" and "control" of the OPD-KJ "structure" axis for inpatients of a pediatric and adolescent psychiatric clinic Abstract. Abstracts: Despite the great importance of structural deficits in adolescent patients, studies on changes that occur in the course of their inpatient psychiatric treatment are lacking. This study assesses the effectiveness of inpatient psychodynamic psychotherapy, the scales "attachment" and "control" of the "structure" axis of Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-KJ). The study was carried out by dual case leaders (psychotherapist and pedagogue/nurse) on 75 patients (12-18 years) at the beginning and at end of 8 weeks of therapy. Correlations between the dimensions were investigated Pearson's r. Subsequently, we analyzed the four subdimensions of control and attachment using analyses of variance with repeated measurement (RM-ANOVA) to determine whether and to what extent these different subdimensions changed over time. Finally, we performed analyses of variance with age, sex, and diagnosis as between-person factors to assess their influence on the trajectories of both dimensions. Results show that both the attachment and the control dimension of OPD-CA improved in the course of the adolescents' treatment. This finding, however, was diagnosis-specific: Only adolescents with affective disorders and phobias showed these improvements, whereas no change was found for adolescents with emotional and behavioral disorders beginning in childhood and adolescence. Implications for research and clinical practice are discussed.

Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study

Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study Abstract. Objective: Psychological disorders frequently manifest during adolescence. Because of the multifactorial influencing factors, the courses of the diseases are heterogeneous, from relapsing-remitting to chronic. This study investigated whether the level of structural integration of the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) correlates with later symptomatic burden. Method: This long-term study assessed the levels of structural integration according to the OPD-CA of 60 adolescents (mean age = 15.6; SD = 0.9). Seven years later, we then measured symptomatic burden (SCID axis I and II) and overall burden (GAF, BSI-GSI) (73.3 % follow-up participation rate). Results: The results showed high correlations between deficient structural integration in adolescence and later symptoms and overall burden in early adulthood. Conclusion: The follow-up examination after a 7-year time period showed significant correlations, which argue for the predictive value of structural integration. This suggests that early specific treatment, e.g., in the form of intensive psychotherapy, be urgently recommended in order to influence this course.

How to measure sustained psychic transformations in long-term treatments of chronically depressed patients: Symptomatic and structural changes in the LAC Depression Study of the outcome of cognitive-behavioural and psychoanalytic long-term treatments

ABSTRACTWorldwide, the pressure on psychoanalysis to prove the results of its treatments according to the criteria of so-called evidence-based medicine has increased. While a large number of studies on the results of psychoanalytic short-term therapies are now available, such studies are still largely lacking on psychoanalysis and psychoanalytic long-term therapies. In a large multicentre study, the results of psychoanalytical and cognitive-behavioural longterm therapies in chronically depressed patients were compared, Both psychotherapies led to statistically highly significant changes in depressive symptoms three years after the start of the treatments However, the focus of psychoanalytic treatments is not exclusively on reducing psychopathological symptoms, but on changes in the inner world of the patients that are reminiscent of the goal of psychoanalyses that Freud has characterized as developing “the ability to love, work and enjoy life.” In the German-speaking community, such transformations are called “structural changes.” This article reports results on such structural changes achieved with the help of a sophisticated measuring instrument, the Operationalized Psychodynamic Diagnostics (OPD). These so-called structural changes are compared with symptomatic changes. Three years after the start of the treatments, significantly more patients in psychoanalytical treatments show such structural changes than patients in cognitive-behavioural treatments.

Changes in OPD-CA Axis Structure During Inpatient Psychodynamic Treatment of Adolescents Suffering from Comorbid Disorders of Conduct and Emotions

In a randomized controlled clinical trial (RCT) we evaluated an inpatient psychodynamic treatment for adolescents suffering from mixed disorders of conduct and emotions. The sample consisted of severely impaired adolescents with remarkable deficits regarding psychic structure. The current study wanted to examine if the manualized treatment did not only reduce symptoms but also enhance the structural level of the patients. The axis structure of the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) was used to assess the structural level of N = 46 adolescent inpatients. To examine differences between the patients‘ structural level at the beginning and at the end of inpatient treatment we conducted a repeated measures ANOVA. The overall score as well as the three subscores of the axis structure improved significantly during inpatient treatment. The corresponding effect sizes were large (η(2) = .29 to .47). The inpatient psychodynamic treatment led to significant improvements regarding symptomatology as well as psychic structure. However, further studies with larger sample size and control group data should be conducted to confirm these results.

The Munich Attachment and Effectiveness Study: Study Design and a Case Example

The "Munich Attachment and Effectiveness Study" is a prospective psychotherapy study examining process and outcome of psychoanalytic psychotherapies. The study design and results are exemplified in a single case. At 6 points in time audio-taped and transcribed therapy sessions are evaluated using process instruments (e. g. Psychotherapy Process Q-Set PQS) and interviews (e. g. Operationalized Psychodynamic Diagnostics OPD, Heidelberg Structural Change Scale HSCS, Adult Attachment Interview AAI). In the single case, findings from the psychotherapeutic process (e. g. "therapist is empathic" according to PQS) complement the achieved changes. 5 HSCS problem foci reached level of "restructuring", on the Reflective Functioning Scale a marked change of RF took place and the attachment classification changed over time. The instruments employed in this study corresponded well in assessing change processes in spite of differing theoretical background.

Reliabilität und Konstruktvalidität der OPD-KJ-Achsen Struktur und Behandlungsvoraussetzungen

As an instrument to assess specific psychodynamic dimensions, the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) is widely used in clinical care and psychotherapeutic training. However, the psychometric validation of its axes is partly still missing. The aim of this study was to test the reliability and construct validity of the axes structure and prerequisites of treatment. 171 children and adolescents (aged 4 to 21 years) with a diagnosed psychiatric disorder who began an analytic psychotherapy were additionally assessed with the OPD-CA by their therapists (n = 25) in the context of naturalistic care in private practice. Therapists were all qualified as analytic child and adolescent psychotherapists and underwent a standardized OPD-CA training. Results indicated conceptually meaningful factor structures for both axes tested. These factor structures predominantly followed the conceptually defined dimensions. Internal consistency was high for the axis structure, modest to low fort he axis prerequisites of treatment. Implications and recommendations for a future revision of the OPD-CA with particular respect of single items and their operationalization are discussed.

Interrater-Reliabilität der OPD-KJ-Achsen Konflikt und Struktur

The reliability of the meanwhile widely used Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) is only rarely examined. By means of audiovisual recordings of OPD-CA-interviews with 39 adolescents in the context of a randomized-controlled psychotherapy study for the treatment female adolescents with bulimia nervosa and atypical bulimia nervosa the reliability of the axis conflict and the axis structure were examined. This was carried out by the calculation of Intraklassen-correlations of three raters. The rater agreements ranged from good to excellent, except for impulse control in the axis structure, where the results were satisfactory. The relevance of the results for clinical practice is discussed.

Interrater-Reliabilität und Konstruktvalidität der OPD-KJ-Achse Struktur – Erste Forschungsergebnisse zum Einsatz der OPD-KJ im Rahmen der klinischen Routine

The axis structure of the Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) has proven to be a reliable and valid diagnostic tool under research conditions. However, corresponding data regarding the integration of OPD-CA axis structure into clinical practice is still lacking. Hence, this aspect was examined as part of a randomized controlled clinical trial realized at Asklepios Fachklinikum Tiefenbrunn. Here, the OPD-CA axis structure has been applied to assess the structural level of 42 adolescent patients (15-19 years). In contrast to previous studies, the assessment was not carried out by independent raters using a videotaped OPD-CA interview, but the rating was part of clinical routine procedures. Also under these conditions, inter-rater reliability was high, in particular regarding the four subscales of the OPD-CA axis structure. With respect to construct validity, the results of our study supported a two-factor solution, which is in accordance with the findings of two previous works. One factor corresponded to the dimension "self-regulation" while the other factor included both the dimension "self-perception and object perception" as well as the dimension "communication skills". Implications of the findings for research and practice are discussed.

Anwendung der Operationalisierten Psychodynamischen Diagnostik im Kindes- und Jugendalter bei somatischer Krankheit Eine Pilotstudie bei Patienten mit Anorektaler Malformation

Psychodynamic findings based on the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) in patients with Anorectal Malformations (ARM) in comparison to psychiatric patients were presented focussing the psychic structure. Patients with ARM had significant better psychic structure especially with regard to coping with conflicts and communication of affects. Furthermore typical findings were generated: Patients with ARM had better treatment conditions and more positive relationships. Still they had fewer hypotheses about their disease and greater living burden. Structural strengthes facilitate acceptance and integration of the disease. Nonetheless more attention should be paid to child-oriented psychoeducation for development of age-appropriate hypotheses about the disease. Facing living burden, psychological-psychiatric support should be offered to patients with ARM.

Reliabilität und Validität der OPD-KJ-Achsen

The manual of the Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) is an instrument meanwhile widespread in the clinical practice to assess psychodynamic dimensions. Publications of inter-rater agreement and validity are still outstanding. This study assessed the interrater-reliability and validity for the axis structure and the axis conflict. 60 adolescents between 14 and 17 years, with and without psychic disorders, were diagnosed with the Operationalized Psychodynamic Diagnostics in childhood and adolescence (Arbeitskreis OPD-KJ, 2007) and SCID-II-interviews and questionnaires. A partial sample of 36 OPD-CA-interviews was the data basis for the assessment of inter-rater agreement. Calculations of validity for axis structure and axis conflict were made with the whole sample. Inter-rater agreement for the axis structure and the axis conflict showed good to very good weighted Kappa coefficients among the trained raters. Validity of the axis structure showed good results. The Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) allows a reliable diagnostic of axis structure and axis conflict, if the ratings are done on the basis of semistructured videotaped interviews by trained raters. The axis structure shows validity, while the results concerning the validity of the axis conflict remain unclear.

Die Operationalisierte Psychodynamische Diagnostik (OPD-2): Validität der Achse I „Krankheitserleben und Behandlungsvoraussetzungen”

The Operationalized Psychodynamic Diagnostics System (OPD) was introduced in order to allow for operationalized and reproducible psychoanalytic diagnoses. A revised version of the instrument was published in 2006. Validation studies are lacking for its Axis I, in particular. The aim of the present study is to investigate the validity of Axis I, as well as to test the underlying factors for their plausibility. The instrument was applied to 263 inpatients by trained raters. For testing their validity, OPD measures were compared to a similar self-rating questionnaire (Questionnaire of measuring the motivation for psychotherapy). These measures corresponded well, and the intercategorial differences between different patient groups (split by sex, age and ICD-10 diagnosis) according to our expectations. Moreover, we established feasible factors. Thus, our results show good validity, and a plausible internal structure of the Axis I.

Psychoanalytische Beiträge zur Behandlung in der forensischen Psychiatrie

Two psychoanalytic treatments are described for patients suffering from severe personality disorders who have killed. These treatments have been conducted in a high security hospital and are part of the overall treatment plan for any patient. Structural changes can emerge in the course of long-term continuous treatment which is conducted within the framework of a multidisciplinary team under conditions of physical security. These changes are described and clinically illustrated using the model of mental structure of the Operationalized Psychodynamic Diagnostics (OPD) system. The traumatic effect of “improvement” is emphasized as well as the risk of further enactment of lower severity. The latter might however trigger considerable anxiety in those who are contributing to the care of these patients. This is of importance for the gradual steps of integrating the patient back into the community. The psychoanalytic contributions are considered as necessary immunization against the contagiousness of these disturbances in these settings and also can help clinical teams to have more realistic prognostic expectations.