Psychodynamic Conflicts Research Articles

Understanding Adolescent Mental Health in the COVID-19 Era: A Psychodynamic Approach.

This cross-sectional, case-control study aimed to explore the psychodynamic characteristics that influenced adolescents' mental health during the COVID-19 pandemic. Personality structure impairments, psychodynamic conflicts, defense styles, and mental health issues were examined using the OPD-Structure- and Conflict-Questionnaires, the Defense Style Questionnaire, and the Patient Health Questionnaire in adolescents before (n = 288) and after (n = 451) the COVID-19 pandemic in Germany. Adolescents with mental health issues exhibited greater impairments in personality structure, more immature defense styles, and higher levels of psychodynamic conflicts both before and after the pandemic onset. Comparisons between pre-pandemic and pandemic samples indicated a lower level of the conflict of taking care of oneself versus being cared for in passive mode among adolescents during the pandemic. In-depth analysis of adolescents with mental health issues from the pandemic group revealed significant associations between personality structure impairments and a maladaptive defense style with somatoform, depressive, anxiety, eating, and alcohol use disorders. The findings provide clinically relevant insights into the psychodynamic factors that contributed to the psychological vulnerability of adolescents during the COVID-19 pandemic. These insights can guide the development of targeted psychodynamic interventions to support adolescents' mental health in similar future crises.

Unravelling inter-relations within and between psychodynamic constructs and psychopathology using network analysis.

Psychodynamic constructs and psychopathology are closely inter-related, but more detailed insight is needed. We investigated these complex inter-relations using network analysis. A Gaussian graphical model in a sample of N = 2232 psychotherapeutic inpatients was estimated. Self-administered questionnaires to assess interpersonal relations (Inventory of Interpersonal Problems-32), psychodynamic conflicts (Operationalized Psychodynamic Diagnosis-Conflict Questionnaire), personality functioning (Operationalized Psychodynamic Diagnosis-Structure Questionnaire-Short Form, Inventory of Personality Organization-Short Form), and psychopathology (Brief Symptom Inventory) were utilized. We investigated the network structure, identified the most inter-related psychodynamic constructs and the psychodynamic constructs with the strongest inter-relations to psychopathology, and explored the clustering of all included constructs. Active and passive conflict processing modes were negatively inter-related in most conflicts. Passive conflict processing modes were more strongly related to psychopathology than active ones in all conflicts, apart from the care versus autarky conflict. Identity diffusion shared the strongest inter-relations within psychodynamic constructs. The psychodynamic constructs that were most strongly related to psychopathology were impairments in self-perception and the passive self-worth conflict. Psychopathology and psychodynamic constructs formed distinct clusters. Our results emphasize the relevance of personality functioning within psychodynamic constructs and in relation to psychopathology.

Associations between Personality Structure, Psychodynamic Conflicts and Defense Styles in Adolescents with Mental Health Problems

An exploration of the interrelationships between central psychodynamic constructs in adolescents with mental health problems was conducted. 230 adolescents (Mage=18.0±1.9) were assessed using the Structure and the Conflict Questionnaire of the Operationalized Psychodynamic Diagnosis System in Childhood and Adolescence and the Defense Style Questionnaire for Adolescents. Controlling for the influence of gender, age, and socioeconomic status, low to moderate associations were revealed between increased psychodynamic conflict levels and immature defense styles (r=0.20 to 0.39, p<0.05 to 0.001) as wells as deficits in the personality structure and increased psychodynamic conflict levels (r=0.15 to 0.55, p<0.05 to p<0.001) or immature defense styles (r=0.30 to 0.69, p<0.001). Psychodynamic conflicts as well as defense styles could be predicted by the structural dimensions as well as age and sex (R2=0 .04 to 0.49, p<0.05 to 0.001). Theory-compliant correlations were demonstrated. The findings are particularly relevant against the background of the revision of the classification of personality functioning (ICD-11) in childhood and adolescence.

Operationalized Psychodynamic Diagnostic of Adolescents in Light of the New ICD-11 Model of Personality Functioning: Personality Structure, Psychodynamic Conflicts, and Mental Health Problems.

The International Classification of Diseases and Related Health Problems, 11th Revision introduced a fully dimensional approach to personality disorders which conceptionally converges with the long-standing psychodynamic understanding of psychopathology through underlying intra- and interpersonal impairments. In this study, the diagnostic contributions of the two psychodynamic concepts of personality structure and psychodynamic conflicts were investigated through the comparison of self-report data of 189 adolescents with mental health problems and 321 mentally healthy controls. The study results reveal that adolescents with mental health problems show significantly higher impairments in all four domains of personality structure and significantly higher levels of several psychodynamic conflicts. Further, adolescents with different mental health problems significantly differ regarding the impairments in the personality structure domains and several levels of psychodynamic conflicts. While higher structural impairments are shown in adolescents with eating and anxiety disorders, higher levels of the passive self-worth conflict persist in adolescents with depressive disorders, and higher levels of the passive identity conflict are affecting adolescents with eating disorders. The findings suggest that a standardized diagnostic assessment of personality structure and psychodynamic conflicts in adolescent patients could contribute to a deeper understanding of mental health problems and appropriate treatment planning through the detection of underlying intra- and interpersonal impairments.

How are psychodynamic conflicts associated with personality functioning? A network analysis.

Personality functioning and psychodynamic conflicts are central constructs in psychoanalytic theories of psychopathology as well as in many psychodynamic treatment models. Although there has been a longstanding conceptual discussion on how they relate to each other, empirical evidence on this question is still scarce. In this study, we explore the associations between psychodynamic conflicts and levels of structural integration (which can be used synonymously with personality functioning) by means of a partial correlation network analysis in a sample of N = 220 outpatients interviewed and rated according to Operationalized Psychodynamic Diagnosis (OPD-2). We examined network centrality, bridge centrality, clustering, and network stability. The network analysis resulted in separate clusters for levels of structural integration and conflicts, supporting the assumption of distinct psychodynamic constructs. The greatest association between the two clusters was found between the individuation vs. dependency conflict (C1) and the structural capacity to attach to internal objects. In general, C1 showed significantly greater connections with structural dimensions compared to the other five OPD conflicts included. C1 was also more central in the network compared to most other conflicts, whereas the structural dimensions did not differ in centrality. All structural dimensions were found to be strongly interconnected. C1 showed exclusively negative edges to the other conflicts, suggesting that a profound C1 decreases the probability of other psychodynamic conflicts. We discuss clinical as well as conceptual implications of our findings for psychodynamic diagnosis and treatment.

An Empirical Investigation of Psychodynamic Conflicts in Stable Couples.

Introduction: Previous investigations have shown that stressful and pathological developments in couple relationships can be psychodynamically explained by rigid unconscious couple collusions. This manuscript presents and discusses the findings of a pilot study in which the psychodynamic conflicts of stable and "functioning" couples were empirically explored. Methods: We studied 116 couples (N = 232) who were currently married or in a steady relationship, had at least one child together, and showed no signs of mental disorders. Psychodynamic conflicts were measured using the OPD Conflict Questionnaire, and the Patient Health Questionnaire was used to screen for mental disorders. Results: Significant differences in the mean scores of psychodynamic conflicts between mothers and fathers appeared in the individuation versus dependency conflict, the self-worth conflict, and the guilt conflict. The maternal and paternal self-worth conflicts were associated with their socio-economic status. Parent couples mainly showed positive associations in the same coping modes and correlations between different conflict topics. Discussion: Our results provide initial insights into the psychodynamic conflicts of mothers and fathers from a nonclinical population and indicate that healthy and stable couple relationships are characterized by concordant and health-promoting ways of dealing with inner conflicts. Future longitudinal studies are needed to understand the influences of psychodynamic conflicts on the formation and maintenance of well-functioning and lasting relationships between couples.

“Permissiveness, guiltiness, anxiety”: A qualitative study on emotional meanings of school task procrastination reported by occupational therapy students in South-eastern Brazil

IntroductionAccording to the Medical Subject Headings, the vocabulary used by PubMed, procrastination is ‘the deferment of actions or tasks to a later time, or to infinity’. Studies on procrastination are increasing, especially among university students, gaining prominence in academic literature. However, studies on the procrastination phenomenon have been mainly quantitative, correlating such experiences with clinical and behavioral manifestations. Specific research with occupational therapy students is lacking in the literature.ObjectivesTo interpret symbolic meanings related to life experiences of the procrastination phenomenon of school tasks as reported by occupational therapy undergraduate students, self-referred as procrastinators.MethodsClinical-qualitative design. Data collected through semi-directed interviews with open-ended questions in-depth. Clinical-Qualitative Content Analysis generated categories discussed in the light of the psychodynamic theoretical framework. This study was carried out in a private Brazilian university. The sample was closed by the information saturation criterion.ResultsSeven students were interviewed. Procrastination comes associated with anxiety as productivity, but not reported as an “executive drive”, that would imprison the individual in a vicious cycle. There are defense mechanisms referred to as self-preservation for not assume responsibilities for tasks. Ineffective strategies seem to be experienced by the students to avoid procrastination, but without resolving possible psychodynamic conflicts related to the task.ConclusionsStudents’ procrastination ambivalently affects their daily lives, although they can report the phenomenon as negative. It is suggested further qualitative studies that explore specifically meanings of procrastinating personal activities, in general, considering these individuals will work precisely in a therapeutic approach in the field of occupations of the people.DisclosureNo significant relationships.

A Once Malignant Malady: the Story of Schizophrenia and the Path to Prevention

Schizophrenia is synonymous in the public’s mind with madness. To see someone experiencing a florid psychosis, who has lost the ability to distinguish between the real and the imagined, is to know that you are in the presence of insanity. Schizophrenia has existed for centuries. It’s one of the leading causes of disability in the world, with a lifetime prevalence of about 1 percent of the population. That’s 3.3 million people in the US and 78 million worldwide. Schizophrenia afflicts rich and poor, genders, all races and ethnic groups. Schizophrenia has been subject to many misconceptions, from spiritual affliction to social deviance, psychodynamic conflicts to romanticized notions of iconoclastic creativity. Perhaps, the most significant myth about the disease is that there are no effective treatments or cure. But the reality couldn’t be more different: today’s treatments are effective and often lifesaving. Beginning in the mid-twentieth century, scientific progress has enhanced our understanding of schizophrenia as a brain disorder that disrupts thought, perception, and emotion. Findings of abnormalities in brain structure, biochemical analytes and genetic mutations have revealed its causal mechanisms and have guided the search for effective pharmacologic and psychosocial treatments. This presentation traces the evolution of our social and scientific understanding of Schizophrenia. It will elucidate how science and medicine dispelled the superstition and myth surrounding this ancient malady of the mind and forged a path toward its understanding as a brain disorders and offers affected people, not just humane treatment, but the promise of its ultimate prevention.DisclosureNo significant relationships.

Do Patients With Treatment-resistant Disorders Recover?

This column describes the challenge posed by patients with treatment-resistant disorders. It then reviews a recently published study demonstrating that with adequate treatment and enough time-over a decade-even patients with conditions that were previously considered treatment-resistant and who have high degrees of comorbidity, suicide risk, and a significant number of prior hospitalizations can achieve full recovery in terms of measures of psychodynamic conflicts, symptoms, and overall functioning. These areas of improvement converge and thus appear to be linked, suggesting the transdiagnostic relevance of psychodynamic measures.

Parenting behavior and psychodynamic conflicts: Cross-sectional findings in a normative sample of adolescents and their parents

The present study aims at determining the associations between various dimensions of parenting behavior and the predominance of psychodynamic conflicts. Psychodynamic conflicts are described as non-integrated, temporally persistent, contradictory perspectives of experience and action. The OPD Conflict Questionnaires for children and adults, as well as both the children’s and parents’ versions of the Zurich Brief Questionnaire for the Assessment of Parental Behaviors were used to assess psychodynamic conflicts and parenting behavior in a sample comprising 221 healthy adolescents, 132 mothers, and 76 fathers, respectively. We found that a) controlling parenting behavior decreases with increasing age of adolescents, that b) girls tend to have passive identity and self-worth conflicts, while boys more often have an active oedipal conflict, and that c) girls perceive more maternal warmth and support than boys do. While perceived parental psychological control, especially by mothers, was positively associated with psychodynamic conflicts in adolescents, parental warmth and behavioral control were negatively associated with psychodynamic conflicts in adolescents. The reports from the parents on their parenting dimensions were partly associated with their own psychodynamic conflicts as well as with the conflicts of both their partners and children, respectively. Our findings show that psychodynamic conflicts and psychologically controlling parenting behavior do not only exist in families in which members suffer from mental illnesses but also in “healthy” families. Furthermore, the strong interrelations between psychodynamic conflicts and perceived parenting behavior of both parents and adolescents underline the need for integrated family therapy when adolescents become mentally ill.

Differences in psychodynamic conflicts between healthy adolescents and adolescent patients: Results with the conflict questionnaire

Unconscious conflicts are characterized as temporally persistent, contradictory perspectives of feelings and experiences, which the individual tries to integrate by using an active or passive mode. According to OPD-CA, seven conflict issues can be measured: Closeness versus Distance, Submission versus Control, Taking care of oneself versus Being cared for, Self-worth conflict, Guilt conflict, Oedipal conflict, and an Identity conflict. This study investigates one of the premises of the OPD-CA, that unconscious conflicts occur in healthy children and adolescents just as they do in patients of the same age, but to a much larger extent in patients, so that they downright may lead to symptoms. 299 healthy adolescents and 283 patients (mean age 17.10, SD = 1.94) were examined by using the self-rating of the conflict questionnaire (OPD-CA-CQ). The results indeed show significantly higher conflict levels in the clinical group with a comparable ranking of the most important conflicts in both samples. Of note, the passive processing mode prevailed in both groups. Conceptually, this signifies, that topics such as loyalty towards parents, insecurity, and disorientation with regard to identity and sexuality concern all youth but impair the patient much more than the healthy youth. In conclusion, one of the premises of the conflict axis of the OPD-CA that the topics occur in all adolescents with substantially higher mean levels in the clinical group was confirmed.

One diagnosis—different conflicts: Using the OPD-CA conflict axis as tool for treatment planning

OPD-CA has set itself the goal of collecting important information that goes beyond diagnosis and are helpful for the indication of therapy and the planning of the therapeutic process. The focus of this article is the Conflict axis of the OPD-CA. Using the example of two patients who have the same diagnosis, F93, it is demonstrated that the same symptoms can be based on very different psychodynamic conflicts. These should be dealt with in therapy so that the development-hindering function of intrapsychic conflicts is eliminated. In addition, it makes sense to use other axes of the OPD-CA, such as Prerequisites for treatment, which gives information about the motivation of the patient and his or her resources, and the axis Structure, which examines the structural requirements for long-term psychodynamic therapy. This is also discussed in the two cases and some information on how to proceed in therapy is given. This concerns also additional work with the parents of the patients.

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.

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).

A Naturalistic Study of Time to Recovery in Adults with Treatment-refractory Disorders

Objectives: Individuals with treatment-refractory disorders have high comorbidity. There is little information on whether recovery is possible and how long it might require. We focused on the individual’s recovery using a broad measure of psychopathology, regardless of the variety of disorders present. Methods: We recruited 226 adults [mean age 31.0, SD = 10.3; 75.2% female] entering residential treatment for treatment-refractory disorders to delineate their course and outcome. Individuals received periodic Longitudinal Interval Follow-along Evaluation interviews for symptoms and functioning variables for up to 14 years. Periodic psychodynamic and relationship vignette interviews were rated with the Psychodynamic Conflict Rating Scales (PCRS) for a subgroup of 54 subjects. Outcome variables included modeled rates of change, final scores, time to recovery, and time to attaining healthy adaptive functioning, using Kaplan-Meier estimates from time-to-event analyses. Results: Recovery of PCRS Pathological Functioning occurred in 12 (22%) of 54 subjects rated: median time-to-recovery = 11.63 years (CI: 9.64– upper number not calculable). Eight (14.81%) subjects also developed healthy adaptive functioning, with the time-to-attainment for the first quartile at 10.95 years (CI: 7.87 - upper bound not calculable). Recovery from psychopathology was significantly associated with a median percentage recovered in the domains of symptoms (64.29%), functioning (87.50%), and psychodynamic functioning (50%). Although attaining healthy adaptive functioning was less common, it was highly associated with already achieving recovery from dynamic psychopathology, [OR = 57.40, CI 5.80 – 567.83, p = .0001]. Conclusions: These results provided convergent validation of recovery in psychodynamic psychopathology. Some recovered individuals also attained healthy adaptive functioning, which took somewhat longer.

Assessing Psychodynamic Conflicts and Level of Personality Functioning in Women Diagnosed With Vaginismus and Dyspareunia.

Knowledge on etiological and risk factors of genito-pelvic pain/penetration disorder, formerly classified as dyspareunia and vaginismus, is limited. The Operationalized Psychodynamic Diagnosis (OPD) system offers a valuable basis for developmental considerations, and has not yet been used to research sexual pain difficulties in women. We conducted an exploratory pilot study of psychodynamic motivational conflicts and level of personality functioning as defined by the OPD system by means of an anonymous online survey among 24 women who had been diagnosed with dyspareunia or vaginismus. We matched them with 24 healthy controls and compared groups using paired-samples t-tests and Wilcoxon tests. Effect sizes were calculated using Pearson's r. Large effect sizes were found for mean or median differences of several OPD Structure Questionnaire (OPD-SQ) scales (self-reflection, p = 0.002/r = 0.59; affect differentiation, p = 0.007/r = 0.53; self-perception, p = 0.002/r = 0.58; impulse control, p = 0.007/r = 0.53; self-worth regulation, p = 0.008/r = 0.52; self-regulation, p = 0.004/r = 0.56; experiencing affect, p = 0.009/r = 0.53; bodily self, p = 0.008/r = 0.54; OPD-SQ total score, p = 0.007/r = 0.52; internal communication, p = 0.001/r = 0.63) and OPD Conflict Questionnaire (OPD-CQ) scales (guilt conflict active, p = 0.004/r = 0.60; Oedipal conflict passive, p = 0.009/r = 0.51; individuation versus dependency conflict active, p = 0.01/r = 0.52; guilt conflict passive, p < 0.001/r = 0.70; self-worth conflict passive, p = 0.001/r = 0.70; passive mode, p < 0.001/r = 0.68). The problems with personality functioning and more pronounced types of conflicts participants displayed suggest proneness for self-invalidation, internalization and restricted self-perception.

Self-Regulation and Psychodynamics in Bioenergetic Analysis

This article presents ten theses containing theoretical considerations for a postgraduate curriculum as currently tested by the Polish Society for Bioenergetic Analysis. The bioenergetic notion of the self, of affect regulation and of mental defense are modified in order to allow for psychodynamic conflict-, structureand trauma-pathological concepts to be integrated into Bioenergetic Analysis. Among other advantages, this approach facilitates the work with structural disorders (narcissism, borderline personality disorder) in Bioenergetic Analysis.

Putative Markers of Repression in Patients Suffering From Mental Disorders.

Background: The concept of psychodynamic conflict is essential to psychodynamic theory and therapy. In classical psychodynamic therapy, unconscious conflict themes need to be identified by the therapist and brought to the patient’s awareness, in order to work through and ultimately solve them. According to theory, touching upon conflict-related topics leads to arousal, followed by activation of defense mechanisms such as repression. Starting with C.G. Jung’s association studies more than 100 years ago, various proposals have been made to investigate psychodynamic conflicts based on free association and psychophysiological measures. This study presents an attempt to identify and differentiate between psychodynamic conflict themes in patients, using an adopted version of Jung’s paradigm that had in previous studies been applied to healthy subjects.Method: Seventeen patients suffering from depression and other mental disorders associated freely to different cue sentences. Prior to the experimental procedure, patients’ individual psychodynamic conflict types were assessed through clinical interviews. Sentences were either neutral, negative (but not conflict-related), or related to specific types of psychodynamic conflicts. Memory for the first three associations was later tested in an unexpected recall task. Skin conductance response (SCR) was recorded and analyzed together with reaction times (RTs) and self-ratings of emotional valence, arousal, and agreement with cue sentences.Results: Patients showed reduced memory performance for associations to conflict-related sentences in general, compared with negative and neutral sentences. Agreement with conflict-related sentences was lower compared to neutral but not negative sentences. Memory was negatively correlated with RTs and SCR. RTs were longer for conflict types that had been rated as relevant in clinical interviews prior to the association task, compared to the other, non-relevant conflict types.Conclusion: Our study shows that some putative markers of repression of psychodynamic conflicts previously established in healthy participants also occur in patients. Moreover, it provides evidence that general conflict effects differ from specific effects of personally relevant conflicts.

Masochism: A Mixed-Method Analysis of Its Development, Psychological Function, and Conceptual Evolution.

This article reviewed the concept of masochism by using a mixed-method approach to analyze 23 publications from 1924 to 2012 by authors from different psychoanalytic schools. Qualitative analysis showed that most authors emphasized painful early attachments, early injury of self-representation, identification with an abusing parent, and narcissistic injury as core experiences in the early childhood of patients with masochism. The main psychological function of masochism was described as a way of avoiding uncontrollable suffering by willingly undertaking other, milder, more controllable suffering. Quantitative analyses using standardized measures of conflicts, defenses, and motives revealed that most authors described early, global psychodynamic conflicts, developmentally early motives, and both action-level and neurotic defenses in masochism. Correlation analyses showed that although the main ideas in the concept of masochism remained stable over time, emphasis on certain aspects changed. The findings provide a conceptual overview of masochism and hypotheses for further clinical studies.

Assessing Psychodynamic Conflict.

Psychodynamic psychotherapies suggest that symptomatic relief is provided, in part, with the resolution of psychic conflicts. Clinical researchers have used innovative methods to investigate such phenomenon. This article aims to review the literature on quantitative psychodynamic conflict rating scales. An electronic search of the literature was conducted to retrieve quantitative observer-rated scales used to assess conflict noting each measure's theoretical model, information source, and training and clinical experience required. Scales were also examined for levels of reliability and validity. Five quantitative observer-rated conflict scales were identified. Reliability varied from poor to excellent with each measure demonstrating good validity. However a small number of studies and limited links to current conflict theory suggest further clinical research is needed.