White and Gray Matter Abnormalities in Young Adult Females with Dependent Personality Disorder: A Diffusion-Tensor Imaging and Voxel-Based Morphometry Study.

We applied diffusion-tensor imaging (DTI) including measurements of fractional anisotropy (FA), a parameter of neuronal fiber integrity, mean diffusivity (MD), a parameter of brain tissue integrity, as well as voxel-based morphometry (VBM), a measure of gray and white matter volume, to provide a basis to improve our understanding of the neurobiological basis of dependent personality disorder (DPD). DTI was performed on young girls with DPD (N = 17) and young female healthy controls (N = 17). Tract-based spatial statistics (TBSS) were used to examine microstructural characteristics. Gray matter volume differences between the two groups were investigated using voxel-based morphometry (VBM). The Pearson correlation analysis was utilized to examine the relationship between distinct brain areas of white matter and gray matter and the Dy score on the MMPI. The DPD had significantly higher fractional anisotropy (FA) values than the HC group in the right retrolenticular part of the internal capsule, right external capsule, the corpus callosum, right posterior thalamic radiation (include optic radiation), right cerebral peduncle (p < 0.05), which was strongly positively correlated with the Dy score of MMPI. The volume of gray matter in the right postcentral gyrus and left cuneus in DPD was significantly increased (p < 0.05), which was strongly positively correlated with the Dy score of MMPI (r1,2= 0.467,0.353; p1,2 = 0.005,0.04). Our results provide new insights into the changes in the brain structure in DPD, which suggests that alterations in the brain structure might implicate the pathophysiology of DPD. Possible visual and somatosensory association with motor nerve circuits in DPD.

Exploring the processes of connection and disconnection in imagery work in a patient with depression and dependent personality disorder.

Imagery work is a useful therapeutic tool in the treatment of depression. It is central in different therapeutic approaches, such as cognitive behavioral therapy and compassion-focused therapy. The clinical case of Cynthia is presented. Cynthia started therapy for severe depression associated with social anxiety and dependent personality disorder. At different key moments in the therapy, the proposed change strategies led to ruptures in the therapeutic alliance. For example, difficulties in accepting depression, fears of being judged by the therapist, guided imagery of compassion and work on the termination of therapy were both triggers of ruptures and spaces for working on the issues linked to the therapeutic relationship. The interactions between different factors of the therapeutic relationship from the perspectives of both the patient and therapist and the implementation of imagery practices in session are presented.

Association Between Personality Traits and Onabotulinumtoxin A Response in Patients With Chronic Migraine.

OBJECTIVE: The aim of this study was to analyze the potential association between personality traits and onabotulinumtoxin A (onabotA) response in patients with chronic migraine (CM). BACKGROUND: Previous studies from a categorial perspective show that patients with CM have anxious or obsessive personality according to the Salamanca screening test. However, the influence of personality traits in onabotA response in patients with CM has not yet been studied. We hypothesize that cluster C personality traits may be associated with non-response to onabotA. METHODS: This case-control observational study includes patients with CM who received at least 2 treatment cycles of onabotA in 2 headache units between January and May 2018. onabotA response was defined as a reduction of at least 50% in the number of monthly migraine days. Personality traits were evaluated using the Salamanca questionnaire, a validated categorial inventory assessing 11 personality traits. RESULTS: One hundred and twelve patients, 100/112 (89.6%) females, mean age (standard deviation): 43 (11) years, were recruited. 96/112 (85.7%) achieved response to onabotA. Dependent trait was significantly associated with non-response to onabotA (P = .008; OR: 0.223 [95%CI: 0.074 to 0.675]). Significant association with other personality traits or confounders was not found. CONCLUSIONS: To the best of our knowledge, this is the first study showing personality traits may predict onabotA response in patients with CM. The presence of dependent personality trait in patients with CM is associated with non-response to onabotA.

Psychotherapy of Dependent Personality Disorder: The Relationship of Patient-Therapist Interactions to Outcome.

OBJECTIVE: So far, only a few studies have focused on psychotherapy for Dependent Personality Disorder (DPD). DPD is marked by a repetitive pattern of efforts aiming at maintaining close relationships, which may present as a lack of assertiveness and as a difficulty in making routine decisions. The present study aims at exploring processes of change taking place during the working phase of a clarification-oriented psychotherapy (COP) by focusing on the in-session patient-therapist interaction, as it changes during treatment and their links with treatment outcome. Methods: N = 74 patients with DPD were recruited in a naturalistic setting; they underwent long-term COP. Sessions 15, 20 and 25 were video- or audio-recorded and analyzed using the Process-Content-Relationship Scale, an observer-rated instrument that measures the quality of the interaction processes from patient's and therapist's perspectives. Therapy outcomes were assessed with the Personality Inventory - Dependency Subscale, Beck Depression Inventory, Inventory of Interpersonal Problems and Self-efficacy Scale at intake and discharge of therapy. Three-level Hierarchical Linear Modeling was applied to test the hypotheses. Results: Improvement in interaction processes was observed in all patient's and therapist's variables over the sessions 15, 20, 25. Overall, this increase in quality of interaction process was unrelated with outcome, but decrease in dependency traits was predicted by increase in therapist's quality of relationship offer, understanding of content and directivity over the course of the working phase of COP. Conclusions: Studying interaction processes in DPD provides an initial understanding of differential roles of potential mechanisms of change in effective treatment.

Dimensional clinical personality inventory-2: investigating key factors on the assessment of dependent personality disorder.

Dimensional literature reinforces the relevance of specific Dependent personality disorder (DPD) traits, as submissiveness, insecurity and avoidance of abandonment. In this paper we measured these traits through the Dimensional Clinical Personality Inventory-2 (IDCP-2). This study aims to verify the capacity of IDCP-2 factors to discriminate and predict DPD related symptoms. From a dataset with 4,503, a total of 305 people was divided in three groups: the community group (n = 200), the non-DPD group (N = 84), and the DPD group (n = 21). We administered six factors from IDCP-2, Insecurity, Abandonment Avoidance, Self-devaluation, Submissiveness, Masochism, and Self-driven Hopelessness. Groups comparison were significant, showing high effects in mostly cases. Multiple regression analysis showed the best predictors of the groups, i.e. Abandonment Avoidance and Self-driven Hopelessness. The findings of this study demonstrate that IDCP-2 covers the core traits of DPD, therefore, being a valid and applicable measure to discriminate DPD, which is particularly relevant in clinical settings. Although our findings suggested two factors as the most relevant measures to discriminant DPD patients from non-DPD/community samples, we did not suggest the restrict use of the Abandonment Avoidance and Self-driven Hopelessness factors for DPD screening. Limitations of the study were discussed.

A Big Five facet analysis of sub-clinical dependent personality disorder (Dutifulness).

This study aimed to examine a Big Five, normal personality trait, "bright side" analysis of a sub-clinical personality disorder: Dependency Personality Disorder. Around 6000 British adults completed the NEO-PI-R which measures the Big Five personality factors at the domain and the facet level. They also completed the Hogan Development Survey (HDS) which has a measure of sub-clinical Dependency Personality Disorder called Dutiful as one of its eleven dysfunctional interpersonal tendencies. Correlation and regression results confirmed many of the associations between the Big Five domains and facets and sub-clinical Dependency. The Dutiful (Dependent) scale from the HDS was the criterion variable in all analyses. The results showed that those high on Dutiful are highly unstable Neurotic, Agreeable people who are low on Openness. They are Anxious, Compliant, Self-Conscious, Unassertive and Vulnerable. It is thus possible to assess subclinical personality disorder "dark-side" traits, like Dutifulness, in terms of normal "bright-side" traits. Limitations of the study are acknowledged.

Associations between personality disorders and cannabis use and cannabis use disorder: a population-based twin study.

BACKGROUND AND AIMS: Individual differences in DSM-IV personality disorders (PDs) are associated with increased prevalence of substance use disorders. Our aims were to determine which combination of PDs trait scores best predict cannabis use (CU) and cannabis use disorder (CUD), and to estimate the size and significance of genetic and environmental risks in PD traits shared with CU and CUD. DESIGN: Linear mixed-effects models were used to identify PD traits for inclusion in twin analyses to explore the genetic and environmental associations between the traits and cannabis use. SETTING: Cross-sectional data were obtained from Norwegian adult twins in a face-to-face interview in 1999-2004 as part of a population-based study of mental health. PARTICIPANTS: Subjects were 1419 twins (µage  = 28.2 years, range = 19-36) from the Norwegian Institute of Public Health Twin Panel with complete PD and cannabis data. MEASUREMENTS: PD traits were assessed using DSM-IV criteria. Life-time CU and CUD were based on DSM-IV abuse and dependence criteria, including withdrawal and craving. FINDINGS: After adjusting for age and sex, antisocial [ß = 0.23, 95% confidence interval (CI) = 0.19-0.28] and borderline PDs (ß = 0.20, 95% CI = 0.14-0.26) were associated strongly with CU. Antisocial (ß = 0.26, 95% CI = 0.21-0.31) and borderline PDs (ß = 0.12, 95% CI = 0.06-0.18) were also linked strongly to CUD. Genetic risks in antisocial and borderline PD traits explained 32-60% of the total variance in CU and CUD. Dependent and avoidant PDs explained 11 and 16% of the total variance in CU and CUD, respectively. CONCLUSIONS: Individual differences in the liability to cannabis use and cannabis use disorder appear to be linked to genetic risks correlated with antisocial and borderline personality disorder traits.

Unhealthy dependency in victims and perpetrators of child maltreatment: A meta-analytic review.

OBJECTIVE: Theoretical conceptualizations of interpersonal dependency and dependent personality disorder suggest that (a) high levels of dependency in parents may increase risk for perpetration of child abuse and neglect and (b) children who are victimized may show elevated levels of dependency later in life. This study used meta-analytic techniques to examine these hypothesized links. METHOD: A systematic search of psychological and medical online databases revealed 14 published studies (21 effect sizes) examining the link between parental dependency and perpetration of abuse or neglect (overall N of perpetrators = 1,321), and 14 published studies (25 effect sizes) assessing dependency in victims of child abuse and neglect (overall N of victims = 38,265). RESULTS: The dependency-abuse effect size (d) for perpetrators collapsed across all moderating variables was 0.36, which is considered to be in the medium range. The dependency-victimization effect size (d) collapsed across all moderating variables was 0.29, also a medium effect size. CONCLUSION: These results support and extend analyses of the relationship between dependency and child maltreatment, and suggest that dependency may be both a precipitant of child maltreatment and consequence of victimization. Theoretical and clinical implications are discussed, with suggestions for further research outlined.

Cooperation in psychotherapy increases metacognitive abilities: a single-case study.

INTRODUCTION: Both clinical observations and empirical data suggest that the ability to think about the mental states of themselves and others (i.e., metacognition) is a crucial factor strongly associated to the outcome of individual psychotherapies. Although it has been hypothesized that the activation of cooperation between patient and psychotherapist within psychotherapy sessions may increase metacognitive abilities, few data is still available to support this hypothesis. METHODS: We explore the association between cooperation of patient and psychotherapist and the modifications of metacognition abilities along five sessions of a patient with a personality disorder using the Assessing Interpersonal Motivations in Transcripts method (AIMIT) and the Metacognition Assessment Scale (MAS). RESULTS: Our data showed that the activation of cooperation was positively associated with both the MAS total scores and all MAS sub-scales. DISCUSSION AND CONCLUSION: Our results demonstrate that the activation of the cooperation within therapeutic relationship can increase patient's metacognition and its subsystem (e.g. self-monitoring).

Personality Disorders in Primary Care: Impact on Depression Outcomes Within Collaborative Care.

BACKGROUND: Individuals with personality disorders (PDs) are high utilizers of primary care and mental health services; however, they struggle to utilize the care effectively and studies have shown a strong association between having a PD and higher impairment in social role functioning. This is especially important because PDs are highly comorbid with a wide range of other mental health disorders. The collaborative care model (CCM) for depression was developed with an emphasis on patient engagement and aimed to reduce health care utilization, while improving treatment outcomes in primary care. We hypothesized that the diagnosis of a personality disorder in primary care patients will negatively affect 6-month depression outcomes after enrollment into a CCM. METHODS: This retrospective chart review study was conducted on patients enrolled into CCM over a period of 7 years with collection of 6-month follow-up data. A total of 2826 patients were enrolled into CCM with a clinical diagnosis of depression and a baseline Patient Health Questionnaire-9 (PHQ-9) ≥10 were included in the study cohort. Using the depression database, baseline and 6-month follow-up data were obtained. Adjusted odds ratios (AORs) were determined for both remission and persistent depressive symptoms using logistic regression modeling for the 6-month PHQ-9 outcome; while retaining all the study variables. RESULTS: Of the 2826 CCM patients with depression in our study, 216 (7.6%) were found to have a PD. Patients with PD were younger (37.7 vs 42.5 years, P < .001) and more likely to be unmarried (36.1% vs 55.6%, P < .001) than patients without a PD. While age, marital status, clinical diagnosis, and Mood Disorders Questionnaire (MDQ) score were significant predictors of remission; anxiety symptoms, gender, and race were not. The presence of a PD diagnosis was associated with a 60% lower likelihood of remission at 6 months (AOR = 0.39; 95% CI 0.28-0.54). Conversely, patients without a PD were 2.5 times as likely to experience remission at 6-month remission compared to patients with PD (AOR =2.57; 95% CI 1.85-3.56). CONCLUSION: Patients with a personality disorder were more likely to have a recurrent depressive disorder diagnosis, an abnormal MDQ score, increased anxiety symptoms, and higher baseline PHQ-9 score. Patients with PD had worse CCM outcomes at 6 months with only 25.0% able to achieve remission versus 54.3% ( P < .001) without a PD. The presence of a PD with depression was associated with poor outcomes (reduced remission rates and increased persistent depressive symptoms rates) in comparison to patients without a diagnosis of PD, while treated within CCM.

[Links between depressive disorders and dependent personality disorders: The important effect of locus of control]. / Liens entre la dépression et la dépendance interpersonnelle : l'importance du locus de contrôle.

CONTEXT: Empirical researches have proved that there are powerful correlations between dependent personality and depression. Different hypotheses were described to conceptualize links between these two entities. The dysfunction of attributive style seems to be linked to dependency and to depression. Interpersonal dependency can be considered to be a mode of adaptation to the external direction of the locus of control. The self-esteem so subjected to the climate of social interactions can lead, by the discontinuity of its protective relations, to the depression. In a coordinated model, this study explores psychopathological aspects between depressive cognition, self-esteem and interpersonal dependency. OBJECTIVE: This study tries to support the hypothesis that depression and dependency are consequences of an external locus of control, secondary in deterioration of the self-esteem and the main objective is to highlight correlations between external locus of control, interpersonal dependency, hopelessness and depressive affect. METHOD: The regrouping of 42 patients in a protocol of psychotherapeutic practices allowed the realization of this retrospective study, multicentric within different hospitals or ambulant psychiatric structures of the agglomeration of Lille, during a period of 6 months. The administration of questionnaires (Beck Depression Inventory/Dependent Personality Questionnaire by Tyrer, translated by Loas/Hopelessness Scale by Beck/Powerful others and Chance Scale [IPC] of Levenson, translated by Loas) was included into clinical practice. RESULTS: The main results indicate that external locus of control "powerful others" is significantly correlated with pathological dependency (P<0.0001), depression (P<0.0001) and hopelessness (P=0.02). In addition, the pathological dependency seems to be correlated with external locus "chance" (P<0.05) and external locus "powerful others" (P<0.0001). CONCLUSION: We explored in this study the powerful links joining pathological dependency with depression. These correlations confirm and specify data found in literature. This work is in favor of a conception of external locus of control as a psychopathologic component between depression and dependent personality. This cognitive aspect manifests vulnerability in the depression of the patients suffering from pathological dependency. Also, the place of external locus of control ("powerful others" and "chance") seems to be a cognitive dimension more pathogenic than the internal locus of control. It will be necessary to investigate other psychopathological dimensions such as self-esteem in a longitudinal report. Without neglecting neurobiological vulnerability in depression, it is pertinent to identify this cognitive fragility to optimize the psychotherapies.

Dependent personality features in a complex case of borderline personality disorder.

Borderline personality disorder is a complex disease model as it encompasses a diversity of pathological personality traits and psychopathological symptoms. It is not surprising, therefore, that it is often manifested by personality disorders across all three clusters and accompanied by other mental (Axis I) disorders. This melange makes both psychological treatment and pharmacotherapy especially challenging, and this paper describes the case of a particularly complex case of a 33-year-old Romanian patient, who has a history of severe deprivation in childhood, mood and substance use disorder in association with borderline pathology. In the course of treatment from many sources and interventions, it has become clear that dependence is a key component of the pathology and has been rewarded with a degree of success in management. Copyright © 2016 John Wiley & Sons, Ltd.

One-year follow-up study of first suicide attempts in first episode psychosis: Personality traits and temporal pattern.

OBJECTIVES: The highest suicide rates occur after psychiatric hospitalization or soon after discharge. In addition to other factors, personality traits have been suggested as predictors of suicide attempts (SA) after first episode psychosis (FEP). In this study we examined their temporal pattern and the influence of personality traits on first suicide attempts (fSA) during one year after FEP. METHOD: One-year follow-up of 65 FEP patients. Bivariate and multivariable analyses were performed to explore the relationship between personality traits and fSA. This analysis was also adjusted for a set of sociodemographic, clinical and psychopathological variables. RESULTS: fSAs in the six months following FEP were predicted by higher scores in passive-dependent personality traits (OR = 2.42, 95% CI = 1.15-5.09) and severity of symptoms at onset (OR = 2.00, 95% CI = 1.07-3.76). Severity of symptoms at onset (OR = 2.71, CI = 1.15-6.39) was the most significant predictor of fSA from six to twelve months after FEP. Seventy percent of fSA occurred during the first six months after FEP, decreasing considerably afterwards. CONCLUSIONS: Our study suggests that personality traits play a role in fSA after FEP. Specifically, passive-dependent personality traits emerged as a predictor of fSA in the six months following FEP. Severity of symptoms at onset predicted early and late first suicide attempts. We also found that risk of fSA is highest during the six months following FEP. These results can contribute to the implementation of prevention program.

[On the relationship between emotional dependency and abuse]. / La relation entre la dépendance affective et la maltraitance.

Abuse is a complex psychosocial issue with multiple implications. This paper takes a look at the physical and psychological manifestations of domestic violence, i.e. between adult (romantic) partners as well as abuse of the elderly. Past studies have looked at the relationship between emotional dependency, the occurence and sustainability of abuse and the likehood that a victimized person will terminate a relationship. Indeed, individuals with Dependent Personality Disorder (DPD) or with dependent characteristics present a higher risk of becoming abusive (both physically and mentally) as well as becoming a victim of abuse. Regarding the elderly, the concept of "reverse violence"--where the current abuser was the victim of the senior who is being abused-, also entails dependent relationships. We identified three concepts that are necessary in the understanding of how dependent relationships underpin abuse: Rusbult's model of commitment in intimate relationships, the notion of dependency-possessiveness and Murphy et al's notion of escalating affective dependency. Thus, it is imperative that future studies in the field of domestic violence look at the dynamics of dyads rather than the individuals alone.

Dimensions of dependence and their influence on the outcome of cognitive behaviour therapy for health anxiety: randomized controlled trial.

BACKGROUND: The personality trait of dependence is common in health-seeking behaviour. We therefore examined its impact in a large randomized controlled trial of psychological treatment for health anxiety. AIMS: To test whether dependent personality traits were positive or negative in determining the outcome of an adapted form of cognitive behaviour therapy for health anxiety (CBT-HA) over the course of 5 years and whether dependent personality dysfunction could be viewed dimensionally in a similar way to the new ICD-11 diagnostic system for general personality disorder. METHOD: Dependent personality dysfunction was assessed using a self-rated questionnaire, the Dependent Personality Questionnaire, at baseline in a randomized controlled trial of 444 patients from medical clinics with pathological health anxiety treated with a modified form of CBT-HA or standard treatment in the medical clinics, with assessment on five occasions over 5 years. Dependent personality dysfunction was assessed using four severity groups. RESULTS: Patients with mild and moderate dependent personality disorder treated with CBT-HA showed the greatest reduction in health anxiety compared with standard care, and those with no dependent dysfunction showed the least benefit. Patients with higher dependent traits received significantly more treatment sessions (8.6) than those with low trait levels (5.4) (p < 0.01). CONCLUSION: The results suggest that patients treated with cognitive behaviour therapy for health anxiety respond better if they have moderate dependent personality. The reasons for this may be related to better adherence to psychological treatment and greater negative effects of frequent reassurance and excessive consultation in those treated in standard care. Copyright © 2016 John Wiley & Sons, Ltd.

Dependent personality, separation anxiety disorder and other anxiety disorders in OCD.

BACKGROUND: The purpose of this study was to investigate whether dependent personality and/or general personality dimensions might explain the strong relationships between separation anxiety disorder (Sep-AD) and three other anxiety disorders (agoraphobia, panic disorder and social anxiety disorder) in individuals with obsessive compulsive disorder (OCD). METHODS: Using data from 509 adult participants collected during the OCD Collaborative Genetic Study, we used logistic regression models to evaluate the relationships between Sep-AD, dependent personality score, general personality dimensions and three additional anxiety disorders. RESULTS: The dependent personality score was strongly associated with Sep-AD and the other anxiety disorders in models adjusted for age at interview, age at onset of OC symptoms and worst ever OCD severity score. Several general personality dimensions, especially neuroticism, extraversion and conscientiousness, were also related to Sep-AD and the other anxiety disorders. Sep-AD was not independently related to these anxiety disorders, in multivariate models including general personality and dependent personality disorder scores. CONCLUSIONS: The results suggest that Sep-AD in childhood and these other anxiety disorders in adulthood are consequences of dependent personality disorder (for agoraphobia and panic disorder) or introversion (for social phobia). It is unknown whether these results would be similar in a non-OCD sample.

Beyond passivity: Dependency as a risk factor for intimate partner violence.

Interpersonal dependency in male perpetrators of intimate partner violence (IPV) is an understudied phenomenon but one that has noteworthy clinical implications. The present investigation used meta-analytic techniques to quantify the dependency-IPV link in all extant studies examining this relationship (n of studies = 17). Studies were gathered via an extensive literature search using relevant dependency/IPV search terms in the PsychInfo, Medline and Google Scholar databases. Results revealed a small but statistically significant relationship between dependency and perpetration of IPV in men (r = 0.150, Combined Z = 4.25, p < 0.0001), with the magnitude of the dependency-IPV link becoming stronger (r = 0.365, Combined Z = 6.00, p < 0.0001) when studies using measures of dependent personality disorder symptoms were omitted. Other moderators of the dependency-IPV effect size included IPV measure, type of sample and perpetrator age. These findings illuminate the underlying dynamics and interpersonal processes involved in some instances of IPV and may aid in understanding how to identify and treat male perpetrators of domestic violence.

Assessment of dependency by the FFDI: Comparisons to the PID-5 and maladaptive agreeableness.

The present study explores the validity of the Five Factor Dependency Inventory (FFDI), a measure of dependent personality traits from the perspective of the five factor model, examined across three separate samples and two studies. The first study examined the FFDI with respect to the traits assigned to assess dependent personality disorder (DPD) by the DSM-5 work group, two measures of DSM-IV-TR DPD and three measures of dependent traits, sampling 184 Mechanical Turk participants and 83 students (the latter oversampled for DPD features). Based on responses from an additional 137 students, the second study investigated the role of maladaptive agreeableness in dependency by examining the FFDI in relation to the interpersonal circumplex using three alternative measures. Discriminant validity was provided with respect to DSM-5 traits and the interpersonal circumplex. Incremental validity was provided with respect to the ability of the FFDI to account for variance within DPD measures beyond the variance explained by DSM-5 traits. Implications for the assessment of dependency and the proposed DSM-5 dimensional trait model are discussed.

Indirect self-destructiveness in homosexual individuals.

OBJECTIVES: The aim of this study was to comprehensively examine the syndrome of indirect self-destructiveness in homosexual individuals. METHODS: 156 homosexual individuals (111 males, 45 females) aged 25-35 (mean age of 29.6) and 561 heterosexual individuals (400 males, 161 females) aged 24-36 (mean age of 28.2) were studied with regard to indirect self-destructiveness. The research instrument was the Polish version of the Chronic Self-Destructiveness Scale (CS-DS) including: Transgression and Risk (A1), Poor Health Maintenance (A2), Personal and Social Neglects (A3), Lack of Planfulness (A4) and Helplessness and Passiveness in the face of problems (A5). RESULTS: Homosexual individuals obtained significantly higher scores than heterosexual ones in numerous scales: Indirect Self-Destructiveness - global (general) index (p<0.001), A1-Transgression and Risk (p<0.001), A4-Lack of Planfulness (p<0.001) and A5-Helplessness, Passiveness (p=0.04) There were no significant differences in the Poor Health Maintenance scale (A2). They also achieved significantly higher scores in the subscales assessing using of psychoactive substances. Factor analysis revealed the presence of only one factor both in the group of homosexual and heterosexual individuals. CONCLUSIONS: The research results indicate that, as compared with the group of heterosexual individuals, in the group of homosexuals there occurs a worsening in psychological functioning, which may be also manifested by an increased indirect self-destructiveness index. The increased intensity of indirect self-destructiveness in homosexual individuals may be considered a manifestation of worsened psychological functioning. The homosexual individuals look after their health similarly to heterosexuals.