Impulsivity mediates the association between narcissism and substance-related problems beyond the degree of substance use: a longitudinal observational study.

BACKGROUND: Narcissism has been implied as a putative risk factor for substance use disorders (SUDs). However, previous research did not disentangle the degree of substance use from substance-related problems, the symptoms of SUDs. This preregistered study addressed the open question whether grandiose and vulnerable narcissism and their constituent traits convey specific SUD risk, that is, explain substance-related problems beyond the degree of use. Furthermore, we tested whether impulsivity or substance use motives linked to narcissistic self-regulation mediate this association. METHODS: Narcissism, impulsivity, substance use motives, past-year substance use, and substance-related problems were assessed in 139 (poly-)substance users, 121 of whom completed a one-year follow-up. For significant longitudinal associations between narcissism factors and substance-related problems controlled for the degree of use, we tested impulsivity and substance use motives as mediators. RESULTS: Grandiose narcissism (r =.24, p =.007) and its constituent factors antagonistic (r =.27, p =.003) and agentic narcissism (r =.18, p =.050), but not vulnerable narcissism, prospectively predicted substance-related problems beyond the degree of substance use. Associations of grandiose narcissism and antagonistic narcissism with substance-related problems were fully mediated by impulsivity, but not substance use motives. Impulsivity explained roughly one third of the association of both grandiose (P̂M = 0.30) and antagonistic narcissism (P̂M = 0.26) with substance-related problems. DISCUSSION: We demonstrate that grandiose narcissism- particularly antagonistic but also agentic narcissism- is specifically linked to substance-related problems beyond the degree of substance use. The mediating effect of impulsivity but not substance use motives suggests that impulsivity may be a more important mechanism than narcissistic self-regulation in promoting SUD in narcissism. However, future studies may use more targeted measures than substance use motives to further probe the role of self-regulation. Similar result patterns for alcohol compared to all substances together indicate that mechanisms may be alike across substances. In conclusion, narcissistic individuals may not use substances more but have a higher SUD risk, informing prevention and treatment.

Evaluation of a self-administered iPad®-based processing speed assessment for people with multiple sclerosis in a clinical routine setting.

BACKGROUND: Limited resources often hinder regular cognitive assessment of people with multiple sclerosis (pwMS) in standard clinical care. A self-administered iPad®-based cognitive screening-tool (Processing Speed Test; PST) might mitigate this problem. OBJECTIVE: To evaluate the PST in clinical routine. METHODS: We investigated the feasibility of the PST in both a quiet and a waiting room setting. We assessed the validity of the PST in comparison with the established Symbol Digit Modalities Test (SDMT). We explored associations between processing speed assessments and the Brief International Cognitive Assessment for MS (BICAMS), magnetic resonance imaging (MRI) parameters, and psychological factors. Additionally, we explored the ability of the PST to detect impairment in processing speed compared to the SDMT. RESULTS: The PST was feasible in the waiting room setting. PST and SDMT correlated comparably with the BICAMS, MRI parameters, and psychological variables. Of 172 pwMS, 50 (30.8%) showed cognitive impairment according to the BICAMS; respective values were 47 (27.3%) for the SDMT and 9 (5.2%) for the PST. CONCLUSIONS: The PST performed in a waiting room setting correlates strongly with established cognitive tests. It thus may be used to assess processing speed in a resource-efficient manner and complement cognitive assessment in clinical routine. Despite comparable validity of the PST and SDMT, we identified more pwMS with impaired processing speed using normative data of the SDMT compared to the PST and advise caution, that the common cut-off score of - 1.5 SD from the current PST is not appropriate in Europe.

The peaks and valleys of narcissism: The factor structure of narcissistic states and their relations to trait measures.

Although interindividual differences in narcissism are well studied, little is known about assessing narcissism at the within-person level. To fill this research gap, we investigated whether the narcissism construct is represented in the same way at the between- and within-person levels. We analyzed four established narcissism measures across multiple studies. In each of the studies, participants completed narcissism measures in ecological momentary assessment or daily diary studies. Equivalent construct representation across between- and within-person narcissism (i.e., cross-level measurement invariance) was found. State narcissism measures showed convergent validities for the trait narcissism scales. Moreover, we also found that antagonistic narcissism was most strongly related to within-person variability in narcissism. Our investigation sheds new light on the structure and assessment of narcissism on the within-person level by providing a comprehensive examination of its measurement. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychological and neural correlates of social affect and cognition in narcissism: A multimethod study of self-reported traits, experiential states, and behavioral and brain indicators.

"Lack of empathy" is a diagnostic criterion of narcissism, but the nature of interpersonal functioning in narcissism is still being debated. Both, empathy and narcissism, are multidimensional constructs, and their relation might depend upon contextual factors. We investigated social affect and cognition in narcissism spanning self-reported traits and experiential states (Ecological Momentary Assessment) as well as behavioral and brain indicators (task-related functional magnetic resonance imaging). N = 140 individuals were selected to cover the full dimensional range of grandiose and vulnerable narcissism, including their constituent self-regulatory dimensions of agentic, antagonistic, and neurotic narcissism. Grandiose narcissism was associated with lower social affect at almost all analysis levels. The associations can be attributed to antagonistic self-regulatory dynamics, and are associated with lower brain activation during subjective experiencing of social affect in regions of the salience network. Social cognition was habitually lowered but not impaired in antagonistic narcissism. Our findings do not support a general "lack of empathy." (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Improving adherence to immunosuppression after liver or kidney transplantation in individuals with impairments in personality functioning - A randomized controlled single center feasibility study.

Introduction: Although adherence to immunosuppressive medication is the key factor for long-term graft survival today, 20-70% of transplant recipients are non-adherent to their immunosuppressive medication. Objective: A prospective, randomized, controlled single-center feasibility study was designed to evaluate the impact of a step guided multicomponent interprofessional intervention program for patients after kidney or liver transplantation on adherence to their immunosuppressive medication in daily clinical practice. Materials and methods: The intervention consisted of group therapy and daily training as well as individual sessions in a step guided approach. The primary endpoint of the study was adherence to immunosuppression as assessed with the "Basel Assessment of Adherence to Immunosuppressive Medications Scale" (BAASIS). The coefficient of variation (CV%) of Tacrolimus (TAC) through levels and the level of personality functioning was a secondary endpoint. We conducted six monthly follow-up visits. Results: Forty-one age- and sex-matched patients [19 females, 58.5 (SD = 10.56) years old, 22 kidney- and 19 liver transplantation] were randomized to the intervention- (N = 21) or control-group (N = 20). No differences between intervention- and control groups were found in the primary endpoint adherence and CV% of TAC. However, in further exploratory analyses, we observed that individuals with higher impairments in personality functioning showed higher CV% of TAC in the controls. The intervention might compensate personality-related susceptibility to poor adherence as evident in CV% of TAC. Discussion: The results of the feasibility study showed that this intervention program was highly accepted in the clinical setting. The Intervention group could compensate higher CV% of TAC after liver or kidney transplantation in individuals with lower levels of personality functioning and non-adherence. Clinical trial registration: ClinicalTrials.gov, identifier NCT04207125.

Do highly sensitive persons display hypersensitive narcissism? Similarities and differences in the nomological networks of sensory processing sensitivity and vulnerable narcissism.

BACKGROUND: Individuals with high sensory processing sensitivity (SPS) ("highly sensitive persons") are thought to be easily excitable and overwhelmed, highly attentive to aesthetic impressions, and particularly sensitive to sensory stimulation. Public discourse suggests that those who describe themselves as highly sensitive see themselves as fundamentally different from others, and view their personality as a gift and a burden. From a clinical personality perspective, high sensitivity could be considered to have substantial overlaps with hypersensitive narcissism, or generally vulnerable narcissism. METHOD: We investigated the associations and shared nomological networks between high sensitivity and hypersensitive narcissism in two studies using convenience and representative samples (n1 = 280, n2 = 310). RESULTS: There is evidence for replicable associations between SPS and hypersensitive (.53 ≤ r ≤ .54) as well as vulnerable narcissism (.44 ≤ r ≤ .54), associations were not attributable to general neuroticism. Nomological networks were similar and pointed to a neurotic-introverted personality profile with reduced personality functioning. Latent class analyses further pointed to substantial and practically relevant person-level covariance. CONCLUSION: Sensory processing sensitivity and hypersensitive narcissism are substantially related constructs. For clinicians, this points to the importance of being attentive to narcissistic self-regulatory strategies in individuals presenting as highly sensitive.

Validation of the German Five-Factor Narcissism Inventory and Construction of a Brief Form Using Ant Colony Optimization.

Narcissism is a multifaceted construct commonly conceptualized as comprising grandiose and vulnerable aspects in a two-factor model. While the manifold correlates of these aspects imposed a challenge for research on the structure of narcissism, recent models converge in a three-factor structure of agentic-extraverted, antagonistic, and neurotic aspects, capturing variance in different conceptualizations and correlates of narcissism. We construct and validate a German adaptation of the Five-Factor Narcissism Inventory (FFNI), a measure assessing these aspects based on the Five-Factor Model. In eight samples (N = 2,921), we found the German FFNI to align with both, two- and three-factor models. The factors display good criterion validity with other narcissism measures, (non-)clinical personality dimensions, interpersonal styles, and (mal-)adaptive adjustment. Neurotic and antagonistic narcissism discriminated between individuals with/without mental disorder diagnoses, and displayed a characteristic profile in incarcerated offenders. Since the FFNI is comprehensive but long, we constructed a 30-item brief form (FFNI-BF) optimizing the internal structure and external validity using ant colony optimization. The FFNI-BF displayed good psychometric characteristics and similar, in certain aspects even advantageous criterion validity. We conclude that the German FFNI validly measures key aspects of narcissism, and the FFNI-BF captures these in a concise manner.

Lay theories of grandiose and vulnerable narcissism.

In public discourse, narcissism is often portrayed one-sidedly and overly negative, rendering a picture of narcissistic individuals as "toxic people" or "evil characters". Beyond these salient associations, psychological theories point to a more complex phenomenon, and different developmental mechanisms are being discussed in relation to it. We investigated the prevalence of different implicit theories on narcissism including beliefs about its developmental antecedents. We put forward the question whether grandiose and vulnerable narcissistic behaviors are regarded as congruent or incongruent expressions of underlying feelings and motives, that is whether grandiose behavior is attributed to underlying grandiosity or underlying vulnerability, and vice versa. Results of an online survey (N = 177) show higher agreement with congruent rather than incongruent theories (i.e., grandiose narcissism is attributed to feelings of superiority rather than inferiority, vulnerable narcissism is attributed to inferiority rather than superiority). In line with this, participants displayed predominant beliefs in parental overvaluation as a developmental antecedent of grandiose narcissism/parental coldness as an antecedent of vulnerable narcissism. With higher self-reported prior knowledge of narcissism, endorsement of theories assuming incongruencies increased. The likability of narcissism was not associated with endorsement of the different implicit theories, but instead with perceivers' own narcissism levels. Results suggest that laypeople employ an "it is what it seems" - heuristic facing both grandiose and vulnerable narcissistic behaviors and are less likely to attribute grandiose or vulnerable behavior to incongruent motivational states. Findings might help to better understand the public image of narcissism and its social consequences. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-020-01296-w.

Social Factors Predict Distress Development in Adults With Pre-existing Mental Disorders During the Coronavirus Disease 2019 Pandemic.

Physical distancing measures during the coronavirus pandemic are associated with increased psychological distress, especially in people with mental disorders. We investigated which social risk and resilience factors influence distress over time in people with pre-existing mental disorders. We conducted a longitudinal online survey with weekly follow-ups between April and July 2020 (n = 196 individuals with, and n = 545 individuals without pre-existing mental disorders at baseline). Our results show that individuals with, but not those without pre-existing mental disorders displayed higher distress levels when social resources and empathic disconnection are low and perceived social isolation is high. The distress development differed between participants with and without pre-existing mental disorders depending on their level of social resources, empathic disconnection, and perceived social isolation. These findings offer specific information for targeted social interventions to prevent an increase in incidence of mental disorders during physical distancing measures.

Assessment of personality functioning in psychosomatic medicine.

BACKGROUND: Personality functioning, also referred to as structural integration, describes basic emotion-related perception and regulation capacities directed towards the self and others. Patients with impairments of personality functioning experience difficulties in self-regulation and interpersonal relations. Although personality functioning has become increasingly important in psychotherapeutic and psychiatric diagnoses and treatment planning, there is little systematic evidence on the role of personality functioning in patients with chronic and somatic diseases. This article reviews empirical studies using standardized assessments of personality functioning in patients with chronic and somatic diseases and discusses the role of personality structure in psychosomatic medicine. RESULTS: Currently, there are only a limited number of studies using standardized assessments of personality functioning in patients with chronic or somatic diseases. The available evidence points to correlations of personality functioning with pain perception and the development of chronic pain. In addition, patients with lower levels of personality functioning may have difficulties in managing chronic conditions that require enduring changes in health behavior, such as in diabetes or posttransplantation therapy. CONCLUSION: The review suggests a systematic link between personality functioning and health behavior in patients with chronic diseases that relate to self-regulation and coping strategies. These findings underline the importance of assessing personality functioning for diagnostics and treatment planning in psychosomatic medicine. Finally, an assessment of personality functioning could be helpful in choosing specific psychotherapeutic treatment strategies; however, more empirical studies are needed to comprehensively prove these assumptions.

The Affective Neuroscience of Sexuality: Development of a LUST Scale.

Background: In recent years, there have been many studies using the Affective Neuroscience Personality Scales (ANPS) to investigate individual differences in primary emotion traits. However, in contrast to other primary emotion traits proposed by Jaak Panksepp and colleagues, there is a considerable lack of research on the LUST (L) dimension - defined as an individual's capacity to attain sexual desire and satisfaction - a circumstance mainly caused by its exclusion from the ANPS. Therefore, this study aims to take a first step toward the development of a standardized self-rate measurement for the L-disposition. For this purpose, two versions of the L-scales (L-12 and L-5) were developed and evaluated regarding reliability and aspects of validity. Materials and Methods: After a pilot study (N = 204; female: 81%) with an initial 20-item pool item reductions were conducted. This led to the construction of a 12-item (L-12) version and a 5-item version (L-5), which were assessed in a second sample consisting of 371 German-speaking healthy adults (58.50% female) aged 18-69 years (M = 28; SD = 9.75). Aspects of external validity were assessed by investigation of correlations with the ANPS, psychiatric symptoms (Brief Symptom Inventory-18), attachment security (Adult Attachment Scales) and personality functioning (Operationalized Psychodynamic Diagnostics Structure Questionnaire). To evaluate structural validity, both L-scales were investigated via confirmatory factor analysis (CFA). Results: Cronbach's α indicated excellent internal consistency regarding L-12 (α = 0.90), while L-5 showed acceptable reliability (α = 0.82). CFA of a bifactor model of the L-12 indicated excellent model fit. Moreover, an excellent model fit was observed regarding a single factor model of L-5. For both scales small to moderate positive correlations were observed with SEEKING, PLAY, and secure attachment, while they exhibited small to moderate negative correlations with SADNESS, insecure attachment, lower personality functioning, and increased psychiatric symptom load. Conclusion: Both newly developed scales exhibit satisfying psychometric properties, indicating high reliability, good structural validity and plausible correlations with external criteria. Hence, this study poses an important step toward the operationalization of the LUST concept. However, more research is needed in particular with respect to the scale's external validity and its applicability in clinical populations.

The nonlinear association between grandiose and vulnerable narcissism: An individual data meta-analysis.

OBJECTIVE: Narcissism can manifest in grandiose and vulnerable patterns of experience and behavior. While largely unrelated in the general population, individuals with clinically relevant narcissism are thought to display both. Our previous studies showed that trait measures of grandiosity and vulnerability were unrelated at low-to-moderate levels of grandiose narcissism, but related at high levels. METHOD: We replicate and extend these findings in a preregistered individual data meta-analysis ("mega-analysis") using data from the Narcissistic Personality Inventory (NPI)/Hypersensitive Narcissism Scale (HSNS; N = 10,519, k = 28) and the Five-Factor Narcissism Inventory (FFNI; N = 7,738, k = 17). RESULTS: There was strong evidence for the hypothesis in the FFNI (ßGrandiose < 1 SD  = .08, ßGrandiose > 1 SD  = .36, ßGrandiose > 2 SD  = .53), and weaker evidence in the NPI/HSNS (ßGrandiose < 1 SD  = .00, ßGrandiose > 1 SD  = .12, ßGrandiose > 2 SD  = .32). Nonlinearity increased with age but was invariant across other moderators. Higher vulnerability was predicted by elevated antagonistic and low agentic narcissism at subfactor level. CONCLUSION: Narcissistic vulnerability increases at high levels of grandiosity. Interpreted along Whole Trait Theory, the effects are thought to reflect state changes echoing in trait measures and can help to link personality and clinical models.

Narcissism in independent and interdependent cultures.

Narcissism can manifest in a grandiose form - admiration-seeking, exhibitionism, and dominance - or a vulnerable form - anxiety, withdrawal, and hypersensitivity. While grandiose narcissism is conceptually in line with an independent self-construal, as prevalent in Western countries, the vulnerable form can be assumed to relate more to an interdependent self-construal, as prevalent in Eastern countries. We studied both forms of narcissism in Germany and Japan (Ns = 258, 280), which differ fundamentally in their independent and interdependent self-construal, yet are similar regarding global developmental standards. We tested whether (1) mean differences in both narcissism forms would conform to the predominant self-construal, (2) self-construal would explain variance in narcissism beyond broad personality traits, and (3) there would be stronger mental health tradeoffs for culturally incongruent forms of narcissism. Our results largely confirm these expectations for vulnerable narcissism, which is (1) more prevalent in Japan than Germany, (2) related to self-construal beyond broad traits, and, (3) more strongly related to mental health problems in Germany than Japan. For grandiose narcissism, data analyses indicated that construct equivalence can only be assumed for the entitlement factor, and internal structure and nomological networks differ substantially between cultural contexts.

Can neuroscience help to understand narcissism? A systematic review of an emerging field.

Narcissism is a Janusian personality construct, associated with both grandiose self-assuredness and dominance, as well as vulnerable insecurity and reactivity. Central questions of intra- and interpersonal functioning in narcissism are still a matter of debate. Neuroscience could help to understand the paradoxical patterns of experience and behavior beyond the limitations of self-reports. We provide a systematic review of 34 neuroscience studies on grandiose, vulnerable, pathological narcissism, and Narcissistic Personality Disorder (NPD), spanning experimental investigations of intra- and interpersonal mechanisms, research on neurophysiological and neuroendocrine aspects of baseline function, and brain structural correlates. While neuroscience has scarcely directly studied vulnerable narcissism, grandiose narcissism is associated with heightened vigilance to ego threat and stress responses following ego threat, as well as heightened stress indicators in baseline measures. Such responses are not commonly observed in self-reports, highlighting the potential of neuroscience to augment our understanding of self-regulatory dynamics in narcissism. Interpersonal functioning is characterized by deficits in social-affective processes. Both involve altered activity within the salience network, pointing to a double dissociation regarding the expression of narcissism and self/other oriented situational focus. Findings are summarized in an integrative model providing testable hypotheses for future research along with methodological recommendations.

Self-Reported Levels of Personality Functioning from the Operationalized Psychodynamic Diagnosis (OPD) System and Emotional Intelligence Likely Assess the Same Latent Construct.

We tested the hypothesis that structural integration, as assessed in the Operationalized Psychodynamic Diagnosis (OPD) system, and emotional intelligence (EI), as studied in personality psychology, might be closely related constructs at a general level, as both might assess general personality functioning. In three studies (n1 = 166, n2 = 204, n3 = 349), we used a self-report measure of OPD structural integration and measures of Trait and Ability EI. Structural integration and Trait EI display very high correlation at general factor level (r = .77 - .82) and almost perfect latent correlation (r = .85 - .90). This correlation cannot be explained away by the general positivity of self-views or socially desirable responding. There is also substantial latent correlation between structural integration and Ability EI (r = .20 - .65). Results replicate over different samples from different countries and extend to the DSM-5 self-report personality functioning scale.

Brain activation during social cognition predicts everyday perspective-taking: A combined fMRI and ecological momentary assessment study of the social brain.

Identifying distinct neural networks underlying social affect (empathy, compassion) and social cognition (Theory of Mind) has advanced our understanding of social interactions. However, little is known about the relation of activation in these networks to psychological experience in daily life. This study (N = 122) examined the ecological validity of neural activation patterns induced by a laboratory paradigm of social affect and cognition with respect to social interactions in everyday life. We used the EmpaToM task, a naturalistic video-based paradigm for the assessment of empathy, compassion, and Theory of Mind, and combined it with a subsequent 14-day ecological momentary assessment protocol on social interactions. Everyday social affect was predicted by social affect experienced during the EmpaToM task, but not by related neural activation in regions of interest from the social affect network. In contrast, everyday social cognition was predicted by neural activation differences in the medial prefrontal cortex - a region of interest from the social cognition network - but not by social cognition performance in the EmpaToM task. The relationship between medial prefrontal cortex activation and everyday social cognition was stronger for spontaneous rather than deliberate perspective taking during the EmpaToM task, pointing to a distinction between propensity and capacity in social cognition. Finally, this neural indicator of Theory of Mind explained variance in everyday social cognition to a similar extent as an established self-report scale. Taken together, this study provides evidence for the ecological validity of lab-based social affect and cognition paradigms when considering relevant moderating factors.

Psychometric properties of the German version of the Youth Psychopathic traits Inventory - short version.

BACKGROUND: The aim of the current study is to examine the psychometric properties of the German Version of the Youth Psychopathic traits Inventory-Short Version (YPI-S). METHODS: A sample of 856 adolescents (age: 15-19) from the German-speaking part of Switzerland was included. All participants completed the 50-item YPI, of which we derived the 18 items of the YPI-S. Furthermore, participants completed the Massachusetts Youth Screening Instrument-Version-2 (MAYSI-2), as well a self-report delinquency questionnaire. RESULTS: We were able to replicate a three-factor structure and found moderate to good internal consistency for the total score as well as for the three dimensions of the YPI-S. Measurement invariance across gender was established. Furthermore, we found positive small to medium correlations with both internalizing and externalizing mental health problems, substance abuse problems, and offending behavior. CONCLUSIONS: Our results suggest that the German version of the YPI-S is a reliable and valid screening instrument for psychopathic traits in both boys and girls from the general population in the German-speaking part of Switzerland.

Healthy Selfishness and Pathological Altruism: Measuring Two Paradoxical Forms of Selfishness.

Selfishness is often regarded as an undesirable or even immoral characteristic, whereas altruism is typically considered universally desirable and virtuous. However, human history as well as the works of humanistic and psychodynamic psychologists point to a more complex picture: not all selfishness is necessarily bad, and not all altruism is necessarily good. Based on these writings, we introduce new scales for the assessment of individual differences in two paradoxical forms of selfishness that have lacked measurement in the field - healthy selfishness (HS) and pathological altruism (PA). In two studies (N 1 = 370, N 2 = 891), we constructed and validated the HS and PA scales. The scales showed good internal consistency and a clear two-dimensional structure across both studies. HS was related to higher levels of psychological well-being and adaptive psychological functioning as well as a genuine prosocial orientation. PA was associated with maladaptive psychological outcomes, vulnerable narcissism, and selfish motivations for helping others. These results underpin the paradoxical nature of both constructs. We discuss the implications for future research, including clinical implications.

Country-level correlates of the Dark Triad traits in 49 countries.

OBJECTIVES: The Dark Triad traits (i.e., narcissism, psychopathy, Machiavellianism) capture individual differences in aversive personality to complement work on other taxonomies, such as the Big Five traits. However, the literature on the Dark Triad traits relies mostly on samples from English-speaking (i.e., Westernized) countries. We broadened the scope of this literature by sampling from a wider array of countries. METHOD: We drew on data from 49 countries (N = 11,723; 65.8% female; AgeMean  = 21.53) to examine how an extensive net of country-level variables in economic status (e.g., Human Development Index), social relations (e.g., gender equality), political orientations (e.g., democracy), and cultural values (e.g., embeddedness) relate to country-level rates of the Dark Triad traits, as well as variance in the magnitude of sex differences in them. RESULTS: Narcissism was especially sensitive to country-level variables. Countries with more embedded and hierarchical cultural systems were more narcissistic. Also, sex differences in narcissism were larger in more developed societies: Women were less likely to be narcissistic in developed (vs. less developed) countries. CONCLUSIONS: We discuss the results based on evolutionary and social role models of personality and sex differences. That higher country-level narcissism was more common in less developed countries, whereas sex differences in narcissism were larger in more developed countries, is more consistent with evolutionary than social role models.

Personality Structure and Attachment in Bipolar Disorder.

BACKGROUND: An impairment of self and interpersonal functioning has an impact on coping strategies, regulation of affect and stress. Little is known so far about the impairment of personality functioning in patients with bipolar disorder (BD). The aim of this study is to assess the effects of personality structure and attachment in BD patients on the symptom burden. METHODS: Forty-six patients with the diagnosis of BD were assessed by the 12-item Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS), the short version of Experience in Close Relationship-revised (ECR-R-D), and the Brief Symptom Inventory-18 (BSI 18) to determine the level of personality functioning, attachment patterns, and symptom load. RESULTS: We observed positive correlations between personality difficulties, insecure attachment, and symptom load in patients with BD. A low level of structural integration and an insecure attachment style in patients with BD were accompanied by a significantly higher symptom load (r = 0.66, p ≤ 0.01). Interestingly, there were no significant differences in the structural integration (T(1.44) = -0.93, p = 0.357) and in the attachment style attachment related avoidance: (T(1,44) = 1.50, p = 0.140); attachment related anxiety (T(1,44) = -0.781, p = 0.439) of study participants with BD when compared to the normative value of the general population. LIMITATIONS: Our limitations are the small sample size of our group and the lack of a control group. CONCLUSION: In general, our results suggest that there is a link between personality structure and affective dynamics including depressive, anxiety, and somatization symptoms in BD. These findings underline the increasing importance of assessing personality structure and attachment for diagnosis and treatment planning of BD.