Crying in psychotherapy: an exploratory mixed-methods study on forms of emotional crying and associated therapeutic interventions.

Emotional tears can be interpreted as expressions of our deepest inner lives, and yet they have largely been ignored in psychotherapy research. This study addresses this gap. Based on grounded theory and using a sequential mixed-methods design, we examined the interaction between therapist and patient during episodes of crying in video-recorded psychotherapy sessions. This resulted in two rating systems: one differentiates forms of patient emotional crying, and the other categorizes therapeutic interventions associated with crying. In this sample, including 46 video sequences from 32 therapy sessions, both rating systems were found to be reliable. To identify potential interactional patterns, we examined the statistical correlation between the two systems through multiple linear regression analyses. We found that certain forms of crying were associated with specific therapeutic interventions. Despite methodological limitations, the study contributes to a subject of clinical relevance that is still in its beginnings. To our knowledge, this is the first study to examine therapeutic events in episodes of crying in a process-oriented and comprehensive way.

All the Same? Different Measures of Personality Functioning Are Similar but Distinct. A Comparative Study from a Psychodynamic Perspective Using Exploratory Graph Analysis.

Personality functioning (PF) is a central construct in many theories of personality pathology. Based on psychodynamic theories, two screening questionnaires to assess PF are widely used: The Inventory of Personality Organization-16 item version and the Operationalized Psychodynamic Diagnosis-Structure Questionnaire Short Form. This study aimed to explore the similarities and differences of the two questionnaires in a large clinical sample of N = 1636 psychotherapeutic inpatients. Correlation analyses were conducted to examine the associations between the global scores and between the subscales. The study further used Exploratory Graph Analysis (EGA) to explore the dimensionality of the items. The stability of estimates was evaluated using a bootstrap version of EGA (bootEGA). The results indicated that the two questionnaires are highly correlated, yet not multicollinear, and moderate to large correlations were found between their subscales. EGA revealed six dimensions that fairly represented the original subscales. BootEGA showed that the dimensions and items were stable, except for one item that did not load sufficiently on any dimension. The findings suggest that although the questionnaires are highly correlated, their subscales tap into distinct domains of PF. We discuss implications stemming from these findings for clinical and scientific practice.

[Quality characteristics and relevance to care of psychodynamic training outpatient clinics:The QVA Project]. / Qualitätsmerkmale und Versorgungsrelevanz psychodynamischer Ausbildungsambulanzen: Das QVA-Projekt.

Introduction: Quality assurance (QA) in outpatient psychotherapy is currently undergoing a process of change. Hitherto, QA has been conducted by means of an expert review procedure (the so-called "Gutachterverfahren"), inter- and supervision as well as further mandatory training. Data-based QA systems have been increasingly discussed in recent years. On behalf of the G-BA, the IQTIG has recently published a draft of a legally binding QA procedure, which has, however, raised substantial concerns and resistance. Design: TheQVA project has two objectives. First, it provides participating training outpatient clinics with a data-driven QA system that enables an automated and risk-adjusted overall evaluation based on relevant patient and referral parameters. Second, the data is used to conduct research on important issues regarding the relevant psychotherapeutic care provided by outpatient clinics. Results: Since the start of data collection in 2022, n = 2058 patients have been recruited so far (March 2023), and a complete baseline diagnostic report has been generated for n = 1112 patients. The cross-sectional analyses of all patients assessed so far show a high burden of depression, interpersonal problems and impaired quality of life with severe impairment of personality functions, pronounced conflict diagnosis and high utilization of inpatient and day hospital treatments. Discussion: This paper describes an easy-to-implement data-based QA system for psychodynamic training outpatient clinics, while at the same time allowing for the examination of healthcare- relevant questions in a large sample. The first experiences show that the system works technically stable and was well-received by the participating outpatient clinics.

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.

Interrater Reliability of Operationalized Psychodynamic Diagnosis 3 (OPD-3).

Objective: The study aims to assess interrater reliability of the revised Operationalized Psychodynamic Diagnosis 3 (OPD-3) system. Three OPD axes were included in the reliability analysis: the Levels of Structural Integration Axis (OPD-LSIA), the Conflict Axis (OPD-CA), and the Interpersonal Relations Axis (OPD-IRA). Methods: A heterogeneous sample of n = 80 patients was diagnostically assessed with SCID-I and SCID-II as well as with an OPD interview. Two raters of a group of five independently rated each patient's OPD interview according to OPD-3. Results: Interrater reliability was good to excellent for OPD-LSIA [ICC1,1 = .874 - .920], and moderate to good forOPD-CA [ICC1,1 = .547 - .764] as well as forOPD-IRA at the aggregated level of Agency and Communion [ICC1,1 = .575 - .793], except for raters' self-perceived tendencies to act towards the patient. Conclusion: The revised OPD-3 can be used as a reliable instrument for a psychodynamic diagnosis of conflicts, levels of structural integration, and dysfunctional relationship patterns.

Exploring the predictive validity of personality disorder criteria.

We tested the predictive validity of personality disorder (PD) indicators at different levels of aggregation, ranging from general PD severity to PD syndrome scales to individual PD criteria. We compared the predictive validity of models on these levels based on interview data on all 78 DSM-IV PD criteria, by using 19 outcome scales in three different samples (N = 651, N = 552, and N = 1,277). We hypothesized that criteria of personality pathology yield a significant increase in predictive validity compared with scales that are aggregated at the syndrome- or general severity-level. We assessed out of sample performance of predictive models in a repeated cross-validation design using regularized linear regression and regression forest algorithms. We observed no significant difference in predictive performance between models trained at the item-level and models trained on scale-level data. We further tested the predictive performance of the trained linear models across samples on outcome measures shared between samples and inspected models for criteria-level information they relied on to make predictions. Our results suggest that little predictive variance is lost when interview items assessing DSM-IV PD criteria are aggregated to dimensional PD scales. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Self-regulation profiles reflecting distinct levels of eating disorder and comorbid psychopathology in the adult population: A latent profile analysis.

OBJECTIVE: Previous research showed that individuals with eating disorders (EDs) can be subtyped by their levels of psychopathology and self-regulation abilities. However, nothing is known about whether self-regulation abilities are solely suited to depict the heterogeneity in ED and comorbid psychopathology in nonclinical samples. Therefore, this study sought to explore self-regulation profiles and their ability to discriminate ED, depression and anxiety disorders, and personality dysfunction in the adult population. METHODS: Within a German representative sample, N = 2391 adults (18-92 years) were examined using latent profile analysis to identify profiles based on established cognitive and emotional self-regulation scales including attention control, cognitive reappraisal, and difficulties in identifying feelings. Profiles were validated with ED, depression, anxiety, and personality dysfunction measures. RESULTS: The final solution selected as best balancing goodness of fit and interpretability included four profiles-High-Functioning, Moderate-Functioning, Dysregulated, and Alexithymic-with high explanatory power of R2  = .99. Profiles were characterized primarily by differences in difficulties in identifying feelings followed by differences in attention control and differed significantly regarding ED, depression and anxiety disorders, and personality dysfunction, with the Dysregulated profile showing the most unfavorable correlates. CONCLUSIONS: This study uniquely revealed that low cognitive and emotional self-regulation were indicators for ED, depression, anxiety, and personality dysfunction in the adult population. Future research should investigate whether the identified profiles predict the development of ED and comorbid psychopathology longitudinally. PUBLIC SIGNIFICANCE: Individuals with eating disorders present with difficulties in cognitive and emotional self-regulation, likely maintaining their symptoms. This representative study in the German adult population sought to build profiles based on cognitive and emotional self-regulation that differed in eating disorder and comorbid psychopathology. We discuss the potential to detect individuals with elevated eating disorder and comorbid psychopathology based on the identified profiles in nonclinical settings.

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.

Can we differentiate between psychoanalytic and psychodynamic psychotherapy? - An empirical investigation of therapists' self-reports.

Therapy differentiation is a crucial component of psychotherapy research. It refers to whether inspected treatments differ from one another. In the history of psychoanalysis, the differentiation between psychodynamic and analytic psychotherapy was often discussed but seldom inspected empirically. In this study, we propose a set of items which should in theory offer the possibility to differentiate between psychodynamic and analytic psychotherapy on session level. We inspect these items using therapists' self-reports concerning N = 295 cases of different psychodynamic and analytic therapies. Results of an exploratory factor analysis and subsequent inspections of the psychodynamic and analytic items in different forms of therapies strengthen the usability of these items for differentiating between psychodynamic and analytic therapy. However, further studies using different perspectives (e. g., observer ratings) are essential. The presented items are a promising step towards the development of an instrument for treatment differentiation which could later be used in treatment comparison studies.

Eating disorder psychopathology: The role of attachment anxiety, attachment avoidance, and personality functioning.

OBJECTIVE: Although the relationship between insecure attachment patterns and eating disorder (ED) psychopathology has repeatedly been demonstrated, the underlying mechanisms of this association are not fully understood. Therefore, the current study aimed to examine personality functioning, defined as an impairment in self and interpersonal functioning, as a mediator between attachment insecurity and ED psychopathology. METHODS: In a representative population-based sample (N = 2508; age range 14-92 years) ED symptomatology, personality functioning, and attachment insecurity (anxiety and avoidance) were assessed. Besides descriptive uni-/bivariate analysis, path analysis was used to test a mediation model while controlling for the effects of age, gender, mental distress, and BMI. RESULTS: ED symptomatology was associated with lower levels of personality functioning (r = 0.22) and higher levels of attachment anxiety (r = 0.14) but did not correlate with attachment avoidance (r = 0.02). Path analysis revealed that personality functioning fully mediated the effect of attachment anxiety on ED symptomatology: The indirect effect via personality functioning (ß = 0.04, p < .001) accounted for 77% of the total effect. Fit indices were excellent. Sensitivity analyses revealed that the main results were mainly applicable to women and the middle age group. CONCLUSION: The present findings contribute to the growing body of research using dimensional conceptualizations of personality functioning, suggesting that it provides an informative, overarching framework for understanding and treating ED psychopathology. Findings indicate that underlying individual differences, e.g., with respect to insecure attachment configurations, have relevant implications for symptom manifestations. Potential clinical implications and avenues for future research are discussed.

[Reliability and validity of the OPD-conflict-questionnaire in an inpatient treatment sample]. / Reliabilität und Validität des OPD-Konfliktfragebogens bei stationären Psychotherapiepatient*innen.

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.

[The development and application of conflict-specific story completion tasks as part of OPD diagnostics in childhood]. / Die Entwicklung und Anwendung konfliktspezifischer Geschichtenergänzungsaufgaben als Teil der OPD-Diagnostik im Kindesalter.

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.

[Functions of language in psychotherapy: A qualitative study of psychotherapists' subjective theories of the "talking cure"]. / Funktionen der Sprache in der Psychotherapie: Eine qualitative Studie zu subjektiven Theorien der "talking cure" von Psychotherapeut*innen.

Functions of language in psychotherapy: A qualitative study of psychotherapists' subjective theories of the "talking cure" Objectives: Psychotherapy is traditionally considered as a "talking cure". The specific functions of verbal activity, however, are disputed. The present study aims at identifying central therapeutic functions of verbal activity. Methods: In qualitative interviews n = 23 psychotherapists with psychodynamic (n = 12) or behavioral (n = 11) background were interviewed regarding their theories of the "talking cure." Based on Consensual Qualitative Research (CQR) a category system of therapeutic functions of verbal activity was constructed. Results: The participants described a wide range of relational, experiential, and behavioral functions of verbal activity in psychotherapy. Psychodynamic therapists emphasized relational and experiential functions of verbal activity, while behavioral therapists emphasized behavioral functions. Conclusions: The findings imply that verbal activity fulfills diverse functions in therapeutic contexts. This suggests a basic verbal materiality of many therapeutic techniques and common factors that needs to be specified in subsequent research.

A Bifactor Model of Personality Organization.

The aim of this study was to explore the viability of a bifactor model for the Inventory of Personality Organization (IPO), which is a self-report measure of personality functioning based on Kernberg's model of personality organization. A heterogeneous, predominantly clinical sample (N = 616) completed the German 83-item version of the IPO. Confirmatory and Exploratory Factor Analyses were applied to explore the factor structure of the IPO. We were able to establish a bifactor model with a general factor of personality functioning and three specific factors (Aggression, Reality Testing, Moral Values), which represent additional dimensions of personality organization. Virtually all items showed substantial positive loadings on the general factor, explaining roughly 66% of the common variance. Furthermore, we found support for convergent and discriminant validity of general and specific factors with regard to interview-based assessments of personality disorders and personality organization. The results lend support to a bifactor approach to Kernberg's model of personality organization. We also present a 30-item brief form of the IPO that efficiently implements the bifactor approach and may be further validated in future studies.

Negative self-conscious emotions in women with borderline personality disorder as assessed by an Implicit Association Test.

Shame and guilt are vital in borderline personality disorder (BPD), and previous research using explicit measures has consistently found elevated levels of these self-conscious emotions (SCE) in those with BPD. However, these measures cannot elucidate implicit processes that are equally important, as they guide the perceptions of the self and influence behavioral responses. Thus, we aimed to extend the research on SCE in BPD utilizing an indirect latency-based measure. A total of 29 female inpatients with BPD and 21 healthy women were assessed with a shame and a guilt self-concept Implicit Association Test (IAT). These two tasks use reaction time measurements to determine the relative strengths of associations between the self versus others and shame versus pride and guilt versus innocence. In addition, participants completed questionnaires capturing shame, guilt, and BPD symptoms. Women with BPD displayed significantly more shame- and guilt-prone implicit self-concepts than the control group (d = 1.2 and d = 0.7, respectively). They also scored significantly higher on explicit measures of shame and guilt. Although explicitly and implicitly assessed shame and guilt were strongly associated with borderline pathology, multivariate models indicated that solely self-reported, but not implicitly measured, guilt was consistently related to all BPD outcomes. Shame was only associated with the number of BPD criteria. This study extends previous findings on SCE in BPD, in that women with BPD do not only explicitly conceive themselves as more shame- and guilt-prone but also exhibit implicitly more shame and guilt self-concepts than healthy controls. Our results may hold clinical and therapeutic implications. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Facial Affective Behavior in Borderline Personality Disorder Indicating Two Different Clusters and Their Influence on Inpatient Treatment Outcome: A Preliminary Study.

BACKGROUND: The purpose of the present study was threefold: first, to investigate the facial affective behavior in patients with a borderline personality disorder (BPD); second, to examine whether these patients could be divided into clusters according to facial affective behavior; and third, to test whether these clusters would influence the inpatient treatment outcome. METHODS: Thirty inpatients with BPD were assessed with the Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID I, SCID II) and had to complete a series of questionnaires before and directly after the 12-week long inpatient treatment. Facial affective behavior was recorded during the structured interview for personality organization (STIPO) and afterward coded with the emotional facial action coding system (EMFACS). Measures on psychopathology [beck depression inventory (BDI), Spielberger state and trait anxiety inventory (STAI), Spielberger state and trait anger inventory (STAXI), and symptom cheklist-90-revised (SCL-90-R)], interpersonal problems [Inventory of Interpersonal Problems (IIP)], and personality organization [inventory of personality organization (IPO)] were administered. RESULTS: Cluster analysis before the treatment yielded two groups that differed in general facial expressivity, and regarding the display of anger, contempt, and disgust. The effect sizes of the repeated measures ANOVAs showed that persons with higher scores on the affective facial expressions benefitted more from the treatment in terms of STAI state anxiety, STAXI state and trait anger, IIP total, and the two scales primitive defenses and identity diffusion of the IPO, whereas persons with lower scores benefitted more on the scale IPO reality testing. CONCLUSION: Our results indicated some initial trends for the importance of facial affective behavior in patients with BPD and their treatment outcome.

Implicitly measured aggressiveness self-concepts in women with borderline personality disorder as assessed by an Implicit Association Test.

BACKGROUND: Aggressiveness resulting from inappropriately intense anger plays a major role in borderline personality disorder (BPD) and research using self-report measures has consistently found elevated levels of aggression in this condition. However, while self-report assesses explicit dimensions of the self-concept, it cannot elucidate implicit processes that are at least equally important as they guide the perceptions of the self and influence behavioral responses. The present study aimed to extend the research on aggressiveness self-concepts in BPD utilizing an indirect latency-based measure. METHODS: Twenty-nine female inpatients with BPD and 21 healthy women were assessed with an aggressiveness self-concept Implicit Association Test (Agg-IAT) using reaction time measurements to determine the relative strengths of associations between the self vs. others and aggression vs. peacefulness. Additionally, participants completed self-report questionnaires capturing aggressiveness and BPD symptoms. RESULTS: Women with BPD had a significantly more aggressive self-concept as indicated by the Agg-IAT than the control group. Moreover, they rated themselves significantly more aggressive on all dimensions than the controls. As expected, correlations between the Agg-IAT and the self-reported aggressiveness dimensions were low (mean r = -.31). LIMITATIONS: The modest sample size and the disregard of a clinical control group limit the generalizability and specificity of our findings. CONCLUSIONS: This study extends prior findings on aggression in BPD in that women with BPD do not only explicitly conceive themselves as more aggressive, but also exhibit implicitly more aggressive self-concepts than healthy controls. Because implicit and explicit self-related operations are related, but distinct processes, our results may hold clinical and therapeutic implications.

[Difficult situations in psychotherapy and how therapists deal with them]. / Schwierige Situationen in der Psychotherapie und wie Therapeuten mit ihnen umgehen.

Difficult situations in psychotherapy and how therapists deal with them Objectives: In theory and research, it is assumed that therapeutic competences are especially relevant in difficult situations. In the present study, we collected and categorized situations that psychotherapists subjectively evaluated as difficult. Additionally, we inspected therapists' reactions to these situations and considered correlations between situations and reactions. Methods: In an online-survey, 101 therapists described difficult situations and their corresponding reactions. The reports were analyzed by qualitative content analysis (Mayring 2015) and resulted in two category systems for the difficult situations and the reactions. Results: Difficult situations reached from everyday conflicts to extreme situations (e. g. threats). The most frequent difficult situations were in context of therapeutic frame, aspects of disorder, and critics, demands, accusations of patients. The most frequent reactions concerned therapeutic frame, external help and supportive interventions. We found significant correlations between difficult situations due to aspects of disorder and asking for external help. Conclusions: Although categories were sometimes difficult to isolate and few cognitive behavioral therapists participated, the collection of difficult situations can be of help for therapists and their training.

The latent structure of interpersonal problems: Validity of dimensional, categorical, and hybrid models.

Interpersonal problems are key transdiagnostic constructs in psychopathology. In the past, investigators have neglected the importance of operationalizing interpersonal problems according to their latent structure by using divergent representations of the construct: (a) computing scores for severity, agency, and communion ("dimensional approach"), (b) classifying persons into subgroups with respect to their interpersonal profile ("categorical approach"). This hinders cumulative research on interpersonal problems, because findings cannot be integrated both from a conceptual and a statistical point of view. We provide a comprehensive evaluation of interpersonal problems by enlisting several large samples (Ns = 5,400, 491, 656, and 712) to estimate a set of latent variable candidate models, covering the spectrum of purely dimensional (i.e., confirmatory factor analysis using Gaussian and nonnormal latent t-distributions), hybrid (i.e., semiparametric factor analysis), and purely categorical approaches (latent class analysis). Statistical models were compared with regard to their structural validity, as evaluated by model fit (corrected Akaike's information criterion and the Bayesian information criterion), and their concurrent validity, as defined by the models' ability to predict relevant external variables. Across samples, the fully dimensional model performed best in terms of model fit, prediction, robustness, and parsimony. We found scant evidence that categorical and hybrid models provide incremental value for understanding interpersonal problems. Our results indicate that the latent structure of interpersonal problems is best represented by continuous dimensions, especially when one allows for nonnormal latent distributions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

[Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study]. / Psychisches Strukturniveau im Jugendalter und der Zusammenhang mit späterer psychischer Erkrankung ­ eine Langzeitstudie.

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.