Identity disturbance in dimensional and categorical models of personality disorder: The incremental value of self-rated identity and narrative identity.

Identity disturbance is increasingly considered to drive personality disorder (PD) onset. Previous research has investigated how identity relates to PD using either self-report scales or narratives to assess identity. Few studies have investigated how both operationalizations relate to one another and to models of PD. More so, no study has investigated whether a narrative identity assessment offers additional explanatory power in understanding PD, beyond what is captured by a self-rated identity assessment, or vice versa. We aimed to address these gaps by administering a rating scale measuring (mal)adaptive identity alongside a prompt to write a narrative about a turning point event to 331 individuals aged 18-30 (72.2% female, Mage = 22.56). Using this multimethod approach, we investigated (a) associations of narrative identity dimensions (agency, communion, exploratory processing) with self-rated identity, self- and interpersonal dysfunction, and symptoms of borderline and antisocial PD, and (b) whether these narrative identity dimensions could explain unique variance in self- and interpersonal dysfunction, and borderline and antisocial PD symptoms, above and beyond self-rated identity, and vice versa. Results revealed significant associations among narrative identity, self-rated identity, and models of PD. Furthermore, communion demonstrated incremental value in explaining PD features, beyond what was accounted for by self-rated identity. However, narrative identity did not offer additional explanatory power in understanding self- and interpersonal dysfunction, beyond self-rated identity. Self-rated identity showed incremental value in explaining all PD models, beyond narrative identity. These results emphasize the importance of employing different methodologies for assessing identity in elucidating how identity disturbance manifests in personality pathology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Narrative identity disturbances in psychopathology: An ecologically valid transdiagnostic framework.

This article presents an ecologically valid transdiagnostic framework regarding narrative identity disturbances in psychopathology. Problems with self and identity are distressing, disruptive to everyday functioning, and central to theoretical models of recovery. Yet these problems are sorely understudied, in part due to differences in concepts, theories, and measurement models across disorder-specific literatures. Disorder-specific theories are useful for understanding the etiology of disturbances to self and identity. However, while root causes may vary across disorders, their effects on explicit, conscious, reflective experience share important transdiagnostic parallels. These problems affect the extended sense of self as an individual with memories, a present identity, and future expectancies. By extension, these problems are developmental, reflecting an ever-evolving conception of oneself across the life course. Finally, these problems are contextual and intersubjective, constructed over time through interactions with others in the family, community, and society. A unified transdiagnostic model for reflective self-disturbances should therefore be idiographic and grounded in developmental and personality theory, with a strong emphasis on ecological validity. Narrative identity is emerging as a coherent, cross-cutting framework for understanding problems with self and identity across diagnostic boundaries. Important current research directions include transdiagnostic samples and clinical control groups; more diverse samples; expanding on the latent structure of narrative identity in clinical populations, and developing new assessment techniques to supplement trained raters. These directions will further enhance narrative identity's utility for idiographic, developmental, and ecologically valid clinical research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

What characterizes a well-functioning person? Perspectives from Scandinavian laypeople and mental health professionals.

Functioning describes how well a person handles life, but the constituents of functioning and its measurement remain subjects of debate among researchers. However, approaches investigating how the concept of functioning is understood among laypeople and practitioners have received less attention. The present study uses a bottom-up approach to explore the concept of functioning among laypeople and mental health professionals in a Scandinavian context. Participants were asked to describe a person doing well in life and a person not doing well in life, resulting in a total of 2,345 statements from 128 laypeople and 78 mental health professionals. Initially, statements were rated according to the meta-concepts of Agency and Communion. This analysis revealed a dominant prevalence of Agency across groups, with laypeople demonstrating a heightened emphasis on Agency when characterizing an individual not doing well in life, suggesting an intensified focus on personal responsibility and achievement when describing dysfunction. Next, an independent semantic domain analysis was used to elucidate and identify distinctive features of functioning within the statements. This revealed a shared conceptualization of functioning among both laypeople and mental health professionals based on three main domains: (1) thriving; (2) daily activities and social roles; and (3) personality features. The findings underscore the importance of considering subjective experiences of thriving, efficacy in managing daily tasks and roles, and personality traits in attaining a comprehensive understanding of functioning levels.

Nursing students' empathic communication: Role in recognizing and treating chronic pain patients.

OBJECTIVE: A substantial body of research supports what many nurses know from experience: empathy is at the heart of providing quality care. The major objective of this study was to identify unique mechanisms through which higher empathy translates into greater intentions to treat patients in pain employing novel methodology. METHODS: Using an ecologically-valid scenario methodology, student nurses (N = 156) reviewed the narrative of a patient in chronic pain. They completed standard, valid measures of empathy toward the patient, perception of the patient's pain, and intention to provide pain-relieving treatment. Nursing student's personality traits were assessed and perception of patients' age and sex were experimentally manipulated. RESULTS: Empathy was associated with higher intention to treat the patient in chronic pain irrespective of patients' age or sex. A moderated-mediation analysis confirmed that nursing students with higher empathy perceived the patient in the scenario as being in greater pain. This was correspondingly associated with higher intention to provide treatment. Nursing students' trait Extraversion was a moderator. CONCLUSION: Empathy not only improves rapport between patients and providers but is related to intentions to provide pain-relieving treatment. PRACTICE IMPLICATIONS: The clinical and educational importance of empathy in patient-provider relationships are discussed.

Attachment-Based Mentalization Profiles of Iranian Children: A Mixed-Method Approach.

Mentalization, operationalized as reflective functioning (RF), is the ability to understand one's own and another's mental world implicitly or explicitly. RF is a newly discovered research field in Iran and is largely under-studied in Eastern cultures in general, underscoring the high need for cross-cultural studies in this field of research. A qualitative method was used to examine the ability to understand, process, and respond to high-arousal attachment situations in typical and clinical populations of Iranian children recruited from a Tehran primary school. A well-known semi-structured interview commonly used to assess RF in children was used to collect data. Required information on internalizing and externalizing symptoms, demographic information, and all formal diagnoses of children were collected by parents. The results indicated the identification of four different profiles of RF in children, one of which was adaptive, while the other three were maladaptive. Also, the results showed that typically developing children and those having a high social and economic status (SES) were characterized as having a more adaptive profile of RF, while children from the clinical population and those with a low SES reported a more maladaptive profile (passive mentalizing, helpless mentalizing, narcissistic mentalizing) of RF. The present study is an important step in increasing our understanding of the development of mentalization in children and has significant educational and clinical implications.

Awareness of Narrative Identity Questionnaire (ANIQ) in Early Adolescents: Psychometric Evaluation and Association with Features of Personality Disorder.

Identity formation is central to adolescent development. Challenges in establishing a stable sense of self is associated with maladaptive identity function, which has been recognized as a core feature of personality pathology. The narrative identity framework offers a unique lens to garner salient information about one's sense of self. The Awareness of Narrative Identity Questionnaire (ANIQ) is a self-report measure of narrative identity validated in adults but is yet to be validated in adolescents. The current study aimed to conduct the first psychometric evaluation of the ANIQ in a sample of 205 youth aged 10-14 years (M = 12.1 ± 1.06 years; 50.7% female; 73.7% Hispanic) recruited from a public charter school. Results confirmed the four-factor structure of the ANIQ and showed high internal consistency. Convergent validity was supported through negative associations between the ANIQ and borderline personality features and identity diffusion. Incremental validity of the ANIQ over identity diffusion in predicting borderline personality features was also examined, but not supported. Overall, results support the ANIQ as a promising instrument for the assessment of narrative identity in youth. However, some improvements to the ANIQ might be necessary in order to use it as a clinical tool in identifying youth with personality pathology.

Personality Disorder and Adolescents-Still Living on a Shoestring?

Personality disorder (PD) has been and continues to be a controversial mental disorder to discuss with young people under the age of 18 [...].

Mentalization in Typically and Atypically Developing Iranian Children and Its Associations with Age, Sex, and Externalizing/Internalizing Symptoms.

Mentalization refers to the ability to understand the mental states of oneself and those of others that motivate action and behavior. Mentalization has generally been linked to adaptive development and healthy functioning whereas diminished mentalization has been associated with maladaptive development and psychopathology. The vast majority of research on mentalization and developmental trajectories, however, is based on Western countries. The overall aim of this study was therefore to examine mentalizing abilities in a novel sample of 153 typically developing and atypically developing Iranian children (Mage = 9.41, SDage = 1.10, Range = 8-11, 54.2% females) recruited from a primary school and health clinic in Tehran. The children completed semi-structured interviews that were later transcribed and coded for mentalization. The parents provided reports on internalizing and externalizing symptoms, demographic information, and all formal diagnoses of the children. The results pointed at general age and sex differences across the two groups. Older children showed more adaptive mentalization compared to the younger children; boys and girls used different mentalizing strategies when facing difficult situations. The typically developing children were better at mentalizing than the atypically developing children. Finally, more adaptive mentalization was associated with lower externalizing and internalizing symptoms among all children. The findings of this study contributes with expanding mentalization research to also encompass non-Western populations and the results hold crucial educational and therapeutic implications.

Narrative Identity within Mentalization-Based Group Therapy for Adolescents: A Feasibility Study.

Borderline personality disorder (BPD) is characterized by severe disturbances related to understanding oneself and other people and can be reliably detected and treated in adolescence. In this feasibility study, we aimed to focus on the features of, and changes in, narrative identity throughout the course of Mentalization-Based Treatment in Groups (MBT-G) for adolescents with BPD. Six female patients (M = 15.2, SD = 0.75) joined between 16 and 31 (M = 23.83) MBT g sessions. The narrated events within each session across sessions were coded for themes of agency and communion and the narrated reactions were coded for personality functioning. The patients and their parents also completed several self-report measures before and after therapy. Themes of diminished agency and communion were identified, with communion as the dominating theme. When comparing the patients' first five sessions with their last five sessions, there was an increase in themes related to agency and decreased in communion. The narrated reactions were dominated by themes related to thwarted self-functioning and primarily identity, although intimacy was also present. Patients improved in terms of self-reported functioning and internalizing and externalizing behavior before and after end of treatment. The importance of narration in BPD (group) therapy is discussed alongside clinical implications.

Attention to emotional stimuli across adulthood and older age: A novel application of eye-tracking within the home.

Previous research has used stationary eye-tracking in the lab to examine age differences in attentional deployment, showing that older adults display gaze patterns toward positive stimuli. This positive gaze preference sometimes improves older adults' mood compared to their younger counterparts. However, the lab environment may lead to different emotion regulation behavior among older adults compared to what they do in their everyday life. We, therefore, present the first use of stationary eye-tracking within participants' homes to examine gaze patterns toward video clips of varying valence and to study age differences in emotional attention among younger, middle-aged, and older adults in a more naturalistic environment. We also compared these results to in-lab gaze preferences among the same participants. Older adults deployed attention more to positive stimuli in the lab but more to negative stimuli in the home. This increased attention to negative content in the home predicted higher self-reported arousal outcomes among middle-aged and older adults. Gaze preferences toward emotional stimuli may thus differ depending on the context, emphasizing the need to explore more naturalistic settings within emotion regulation and aging research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mentalizing mediates the relationship between psychopathy and premeditated criminal offending in schizophrenia: a 6-year follow-up study.

PURPOSE: Research has shown that schizophrenia augments the risk for criminal behaviour and variables both defining- and related to schizophrenia, increase criminal offending. Premeditated criminal offending is considered a severe form of criminal offending, however, very little is known about what predicts future premeditated criminal offending in schizophrenia. METHOD AND MATERIALS: In this 6-year follow-up study we explored which factors underlie future premeditated criminal behaviour in a sample of patients diagnosed with schizophrenia (N = 116). We also investigated if a specific mentalizing profile underlie part of the variance of premeditated criminal offending. RESULTS: Results showed that psychopathy underlie future premeditated crime in schizophrenia, and that a specific mentalizing profile, comprised of a dysfunctional emotional and intact cognitive mentalizing profile in relation to others, mediated parts of the relation between psychopathy and premeditated criminal offending. Finally, our results indicated that patients with schizophrenia with a specific mentalizing profile (see above) engaged in premeditated criminal behaviour earlier during the 6-year follow-up period compared to patients with other mentalizing profiles. CONCLUSIONS: Our findings suggest that mentalization should carefully be inspected in patients with schizophrenia in relation to future premeditated offending.

Synthesizing contemporary integrative interpersonal theory and the narrative identity approach to examine personality dynamics and regulatory processes.

OBJECTIVE: The goal of this paper is to promote the integration of two approaches to personality and assessment: Contemporary Integrative Interpersonal Theory (CIIT) and the Narrative Identity Approach (NI). METHODS: We review CIIT and NI, describe their similarities and differences, and articulate opportunities to integrate the approaches to more fully account for personality dynamics and self-regulation. RESULTS: We identify several areas within which concepts from CIIT and NI could be synthesized and offer four concrete suggestions for integrating the assessment methods within each approach: (1) using narratives to explicate interpersonal perception, (2) using stories to clarify interpersonal context, (3), using the Interpersonal Situation as a framework for unpacking narrative elements, and (4) coding interpersonal sequences in narrative data. CONCLUSIONS: CIIT and NI have potential to augment one another both theoretically and methodologically in ways that would be fruitful for conceptualizing and studying personality dynamics and self-regulation.

Pedagogical stance in mentalization-based treatment.

BACKGROUND: A common aspect of evidence-based treatments for people with borderline personality disorder (BPD) is pedagogical interventions and formats. In mentalization-based treatment (MBT) the introductory course has a clear pedagogical format, but a pedagogical stance is not otherwise defined. METHODS: Treatment integrity was quantitatively assessed in a sample of 346 individual MBT sessions. Nine group sessions and 24 individual MBT sessions were qualitatively subjected to interpretative phenomenological analysis (IPA). RESULTS: The dominating intervention type was MBT Item 16-therapist checking own understanding (31% of the interventions). IPA unveiled the following: (1) a pervasive, but hidden/implicit psychopedagogical agenda, (2) psychopedagogical content seemed precious for the patients, and (3) four tentative strategies for pedagogical interventions in MBT (a) independent reasoning; (b) epistemic trust; (c) mental flexibility; and (d) application of verified insights, knowledge, or strategies. CONCLUSION: Development and clarification of the pedagogical stance in MBT could further improve the quality of therapists' interventions.

Why, How, and When to Integrate Narrative Identity Within Dimensional Approaches to Personality Disorders.

Researchers and clinicians are beginning to adopt dimensional approaches in the study and treatment of personality disorders (PD). Although dimensional approaches in the DSM-5 and ICD-11 hold considerable benefit, they need to better incorporate an appreciation of individuals' life stories, or narrative identities. Doing so will be necessary to flesh out the emphasis that both frameworks place on the role of identity in personality pathology. In this article, the authors review why, how, and when narrative identity theory and research can be integrated within dimensional approaches to PD. The authors describe established ways to assess narrative identity, review extant research on this construct in relation to PD, and signal areas crucial for future research. Stories lie at the heart of what it means to be human. The authors conclude that a greater consideration of the ways in which the self is storied can help further understanding and treatment of PD.

Borderline personality disorder in adolescence: The role of narrative identity in the intrapsychic reasoning system.

Borderline personality disorder (BPD) manifests in adolescents, serving as a forerunner for later dysfunctionality and life constraints. BPD is characterized by multiple difficulties in understanding the self and others, and it has been implied that intrapsychic processes of reasoning might be the primary driver of these disturbances. In this study, we examined the role of narrative identity, the dynamic and evolving story people construct about their personal pasts, presents, and futures, as a potentially important but largely overlooked aspect of temporal reasoning within the intrapsychic system of adolescents with BPD features. A total of 174 American inpatient adolescents (Mage = 15.12 years, SD = 1.52) completed self-report measures of BPD upon hospital admission. Adolescents' narrative identity (i.e., themes/future wishes of agency and communion), mentalizing, and emotion dysregulation were assessed. Results showed that narrative identity (i.e., thwarted themes of agency and communion) was associated with lower mentalizing and higher emotional dysregulation capacities, supporting narrative identity's relation to other relevant aspects of intrapsychic processes of reasoning in BPD. Regression analyses showed that both higher levels of emotion dysregulation and more thwarted narrative themes of agency (but not mentalizing) were significantly associated with BPD features. Intriguingly, narrative identity (i.e., thwarted themes of agency) showed incremental validity in accounting for features of BPD, over and above emotion dysregulation. It is concluded that disturbances related to narrative identity might be a prominent component of the intrapsychic reasoning system in BPD and should be included in future work on the topic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Incorporating narrative repair in the treatment of avoidant personality disorders: A case in point.

Avoidant personality disorder (AvPD) is characterized by multiple struggles, including shyness, feelings of inadequacy, and hypersensitivity to interpersonal judgments. Research indicates that people with AvPD also show disturbances in narrative identity, which is an internal and evolving story created about the personal past, present, and presumed future. Here, the novel Guide for Narrative Repair (GNaR) recently developed by (Thomsen et al., 2020) is introduced as a potentially useful tool to help people with AvPD in crafting more adaptive narrative identities. The guide is brought to life via a case study analysis of Adam, a male outpatient suffering from AvPD. Consistent with the GNaR, disturbances in Adam's storied self are brought to light and ways to facilitate his narrative repair are proposed. We conclude with implications related to the case as well as the potential narrative turn in AvPD treatment.

Storying the Past and the Future: Agency and Communion Themes Among Individuals With Schizophrenia and Depression.

ABSTRACT: Research has linked disturbances in narrative identity with schizophrenia and other psychiatric disorders. One such disturbance is diminished agency and communion themes in past life stories. However, projecting oneself into the future is also central to identity and potentially impacts recovery. Hence, we examined themes of agency and communion in both past and future life stories and related themes to psychosocial functioning in 20 individuals with schizophrenia, 20 individuals with depressive disorder, and 19 nonpsychiatric controls. Participants were asked to describe up to 10 past and future chapters in their life stories and were assessed on psychosocial functioning and neurocognition. Chapters were coded for agency and communion themes. Both clinical groups displayed diminished agency and communion themes in past but not future life story chapters compared with the nonpsychiatric controls. Furthermore, agency themes in future chapters explained variance in psychosocial functioning after controlling for neurocognition. The results suggest that constructing a narrative identity to foster agency and communion in both past and future chapters may be an important part of recovering from schizophrenia and depression.