Psychodynamic Profile Research Articles

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

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

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

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

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

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

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

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

Reliability of the Karolinska Psychodynamic Profile (KAPP) among Patients with and without Psychoactive Substance Abuse Disorders

Background: The Karolinska Psychodynamic Profile (KAPP) is a rating instrument, based on psychoanalytic theory, that assesses different aspects of character from clinical interviews. The aim of the present study was to examine interrater reliability of the KAPP in a sample of patients with and without psychoactive substance abuse disorders, using interviewers and a reliability judge who had not been trained by the developers of the instrument. Methods: The sample comprised 47 consecutive patients with and without psychoactive substance abuse disorders, who were referred to an outpatient psychotherapy unit specializing in the treatment of substance abuse and dependence. The two interviewers and the reliability judge had not been trained by the developers of the KAPP, and they worked outside the setting where it was constructed. Results: The intraclass correlations were satisfactory for the total sample (mean 0.84, median 0.89, range 0.62–0.95), as well as for various subsamples, such as males and females, and patients with and without substance abuse disorders. Conclusions: The results show that interviewers and a reliability judge who had not been trained by the developers of the KAPP can attain high interrater reliability in a sample of patients with substance abuse disorders. Some recommendations for conducting KAPP interviews are given.

Personality predictors of dimensions of psychosocial adjustment after surgery.

Although many studies have examined the relationship between personality factors and adjustment after surgery, most of them have had very short follow-up periods. The present prospective study examines whether preoperative psychodynamic assessment of personality traits enhances prediction of various areas of psychosocial adjustment assessed at least 1 year after surgery. In 53 patients undergoing pelvic pouch surgery for ulcerative colitis, we examined the relationship between personality traits measured before surgery, and postoperative psychosocial adjustment assessed at a median of 17 months postoperatively, controlling for the effect of surgical functional outcome. Personality traits were assessed with the Karolinska Psychodynamic Profile (KAPP). Surgical functional outcome scales and the Psychosocial Adjustment to Illness Scale (PAIS) were used. Problems with sexual satisfaction, perfectionistic body ideals, lack of alexithymia, and poor frustration tolerance predicted poor postoperative adjustment in various areas, beyond what was predicted by surgical functional outcome alone. Moreover, moderate preoperative levels of alexithymia were beneficial to postoperative adjustment in the area of psychological distress. The findings suggest that the preoperative assessment of the patient's long-term sexual functioning and satisfaction, the importance attached to his or her appearance, level of alexithymia, and general capacity to tolerate frustration and set-backs in life, might alert both the surgeon and the patient to potential risk factors for poor postsurgical adjustment.

The Karolinska Psychodynamic Profile (KAPP): Studies of character and well-being.

The Karolinska Psychodynamic Profile (KAPP) is a rating instrument that consists of 18 subscales for assessing different aspects of character from clinical interviews. The psychometric properties of the instrument, including reliability, stability, and some earlier validity studies, are reviewed. The present validity study of the KAPP examines aspects of affect control and its relation to other state and trait measures as well as to psychopathology in 65 ulcerative colitis patients. Cluster analysis was used to classify individuals according to aspects of affect control. Our results suggest that patients with excessive impulse control also have problems coping with aggressive affects, that this co-occurring difficulty is a stable mode of mental functioning in the individual, and that these patients manage quite

The Karolinska Psychodynamic Profile (KAPP): Studies of character and well-being.

The Karolinska Psychodynamic Profile (KAPP): Studies of character and well-being.

The Karolinska Psychodynamic Profile (KAPP): Studies of character and well-being.

The Karolinska Psychodynamic Profile (KAPP): Studies of character and well-being.

Inter‐observer and test‐retest reliability of the Italian version of the Karolinska Psychodynamic Profile in two groups of psychiatric patients

A total of 64 psychiatric patients were tested with the Italian version of the Karolinska Psychodynamic Profile in order to investigate interobserver and test-retest reliability. The mean inter-observer agreement coefficients (rho) ranged from 0.75 to 0.80 with less experienced psychiatrists, while the mean rho value was higher (0.96) with more experienced raters. Test-retest values were good, ranging from 0.53 to 0.93. Overall, reliability was comparable with that reported in the original Swedish study.

Improving the usefulness of the Karolinska Psychodynamic Profile in research: proposals from a reliability study

The interrater reliability of data obtained by use of the Karolinska Psychodynamic Profile (KAPP) was tested among 60 women seeking treatment for drinking problems. The first rater had a psychodynamic background but was minimally trained rating the KAPP subscales and performing KAPP interviews. Independent, blind ratings of audiotaped interviews by an experienced KAPP rater revealed that 8 of the subscales obtained satisfactory reliability, whereas 6 subscales showed unsatisfactory reliability. Furthermore, data for one subscale (normopathy) showed a zero correlation between raters, probably due to the novelty of the construct. Additionally 3 subscales related to bodily aspects were of little clinical significance among the present study group. Our data were compared with data from previous KAPP reliability studies, and the reasons for similarities and discrepancies of results are discussed.

Stability over time of character assessment using a psychodynamic instrument and personality inventories.

In a group of patients with a preoperative diagnosis of ulcerative colitis, the stability of character traits and modes of mental functioning were studied after a major life event, major abdominal surgery, using the Karolinska Psychodynamic Profile (KAPP), an interview-based assessment instrument founded upon psychoanalytic theory. In addition, different personality and temperamental variables were assessed with 2 self-report instruments. The patients were assessed before surgery, and follow-up was made at least 1 year after their final scheduled surgery. Although the patients had undergone major abdominal surgery and convalescence between the assessments, the correlations between the scores before and after surgery were very high, and the levels of the scores were very similar. This was true for all the instruments, indicating that they assessed stable characteristics in the patients. The changes that did occur were mainly in the predicted direction. The results of this study suggest that the KAPP can assess modes of mental functioning and character traits that are relatively stable and only slowly variable.

The concept of alexithymia: an empirical study using psychodynamic ratings and self-reports.

In patients with ulcerative colitis, alexithymia and related traits were studied using the Karolinska Psychodynamic Profile (KAPP), a recently constructed psychodynamic assessment instrument, and other measures of alexithymia (the Schalling-Sifneos Personality Scale (SSPS) and the Beth Israel Questionnaire (BIQ)), and other personality traits using the Karolinska Scales of Personality (KSP). The results of these measures were analyzed for correlation. The prevalence of mental disorder as defined by DSM-III was not above normal, and the KSP T-scores were within normal limits. As rated with the KAPP, alexithymia was uncorrelated with age or level of education, but was inversely correlated with proximity to a major life event (abdominal surgery), suggesting that alexithymia may have a defensive function. Cluster analysis, with Regression in the service of the ego (R), Alexithymia (A) and Normopathy (N) as clustering variables, yielded 3 groups: normal, multidisturbed (problems with R, A and N) and inhibited (problems with R and N). SSPS failed to distinguish between the multidisturbed and the inhibited groups, and BIQ between any groups. In the multidisturbed group, correlations were found with detachment and with disturbances in interpersonal relations. The results suggest that disturbances in object relations are of major importance in alexithymia.

Karolinska Psychodynamic Profile

The Karolinska Psychodynamic Profile, KAPP, is a rating instrument founded upon psychoanalytic theory. Its validity is satisfactory, and high interrater reliability can be attained with modest training of the raters in using the instrument. It enables relatively stable and only slowly variable modes of mental functioning and character traits to be assessed psychodynamically. The profile is based upon eighteen subscales, by means of which these modes of mental functioning and character traits can be represented. The subscales have been chosen with a view to obtaining a comprehensive assessment of modes of mental functioning and character traits, as reflected in the patient's self-image and relationships with others. The subscales and their scale steps have been provided with relatively detailed descriptions which are kept close to clinically observable phenomena. The information needed for making the assessments is obtained through a structural interview procedure. The manual, the subscales and their scale steps, and the assessment procedure is presented.

The Karolinska Psychodynamic Profile. I. Validity and dimensionality

The Karolinska Psychodynamic Profile (KAPP) is a new rating instrument based on psychoanalytical theory that is intended to assess relatively stable modes of mental functioning, as they appear in self-perception and in interpersonal relations. The 18 subscales of the KAPP and their scale steps are described in detail. The information needed for assessment is obtained through a structural interview procedure. The KAPP can discriminate between patients with and without a DSM-III diagnosis. It does not appear to be sensitive to the strain of a major life event. Comparison between interview-based ratings and projective test-based ratings shows satisfactory agreement and similarities in factor structure. The KAPP appears to possess both discriminative and construct validity.

The Karolinska Psychodynamic Profile. II. Interdisciplinary and cross‐cultural reliability

The Karolinska Psychodynamic Profile (KAPP) is a rating instrument based on psychoanalytical theory, that is intended to assess relatively stable modes of mental functioning, as they appear in self-perception and in interpersonal relations. The 18 subscales of the KAPP and their scale steps are described in detail and kept close to clinically observable phenomena. The information needed for assessment is obtained through a structural interview procedure. The interrater reliability was tested with different Swedish raters with varying psychodynamic training and experience. It was also tested with a non-Swedish rater with psychoanalytic training. The interrater correlations were generally high, suggesting that the KAPP has interdisciplinary and cross-cultural reliability.