Intrapersonal dynamics of closeness versus distance: Qualities of the self-concept distinguish destructive overdependence, dysfunctional detachment, and healthy dependency.

INTRODUCTION: People vary in the degree to which they affiliate with others; exaggerated efforts maintain interpersonal closeness versus distance are codified in longstanding categorical models of personality pathology, and in contemporary dimensional frameworks as well. OBJECTIVE: To examine associations between destructive overdependence (DO), dysfuntional detachment (DD), and healthy dependency (HD) and qualities of the self-concept. METHOD: A mixed-sex sample of 229 adults completed the Relationship Profile Test to assess DO, DD, and HD, and the Object Relations Inventory (ORI) to assess qualities of the self-concept. RESULTS AND CONCLUSION: Analyses indicated that (1) the ORI Strong dimension was uniquely predictive of DO (inversely related); (2) ORI Warm and Nurturing were unique predictors of DD (both inversely related); and (3) ORI Nurturing and Successful were unique predictors of HD. This study illuminates key intrapersonal features of these three personality styles.

Intergenerational Trauma, Dependency, and Detachment.

ABSTRACT: The literature on intergenerational transmission of trauma is predominantly focused on the mental health functioning of children and grandchildren of trauma survivors. Research shows that having a traumatized parent is related to increased psychopathology and dysfunctional attachment patterns in the next generation, but little is known about the effects of parental trauma on other aspects of interpersonal relating. The current study addresses this gap. Participants were young adult students from an urban college; individual and parental trauma histories, and indices of unhealthy dependency, dysfunctional detachment, and healthy dependency, were obtained. Results indicated that a wide range of parental traumas were positively correlated with dysfunctional detachment, but not related to destructive overdependence or healthy dependency. These results suggest that a wide range of parental traumas have a negative impact on the next generation's interpersonal dependency by fostering a tendency to distance themselves from close relationships.

Suicidality and Implicit Dependency in Child and Adolescent Inpatients With Histories of Trauma: Moderating Effect of Gender.

ABSTRACT: There is lack of empirical findings on a direct link between suicidality and dependency in youth. This is particularly relevant for children and adolescents with a trauma history, since traumatization is a well-established risk factor for suicidality in this population. Research on dependency predominantly uses self-report assessments, which may be susceptible to biases. In this study, performance-based interpersonal dependency scores in inpatient children and adolescents with trauma history were compared with patients' suicidal behavior (suicidal ideation and suicidal attempts) as derived from chart records. The results showed a gender effect. High dependency scores were associated with higher suicidal ideation for girls and with lower suicidal attempts for boys. These findings demonstrate that a relationship between dependency and suicidality for hospitalized traumatized youth is impacted by gender.

Toward a More Nuanced Perspective on Detachment: Differentiating Schizoid and Avoidant Personality Styles through Qualities of the Self-Representation.

Avoidant personality disorder was introduced in DSM-III (American Psychiatric Association [APA], 1980), and debate persists regarding the utility of having two separate variants of the "detached personality." The present study addressed this issue through ratings of open-ended self-descriptions provided by community adults with high scores on schizoid versus avoidant personality traits (N = 229). The self-concept of individuals with avoidant personality style reflected a lack of positive self-regard and low self-efficacy/agency. Regarding schizoid personalities, neither positive nor negative self-regard, self-complexity, or self-efficacy/agency was found. Examination of specific variables yielded a relationship between avoidant personality styles, depression, and anxiety, consistent with literature noting simultaneous desire and fear of interpersonal relationships in avoidant patients (APA, 1980; Sheldon & West, 1990). Similarly, examination of individual variables yielded a negative association between schizoid personality styles and tolerance for contradictory aspects of the self, consistent with theoretical writings in this area (Kernberg, 1976; McWilliams, 2006). Results support the argument that these two personality styles represent distinct constructs. Findings support the utility of self-concept assessment to assist treatment planning and differential diagnosis. Treatment implications include using open-ended descriptions of patients' self-concepts to explore changes that may not be accessible via more structured forms of patient self-report.

Dependency, Detachment, and Health-Related Behavior in Adult Primary Care Patients.

This investigation examined links between three related personality styles as assessed with the Relationship Profile Test-destructive overdependence, dysfunctional detachment, and healthy dependency-and indices of health and health-related behavior in a mixed-sex (74% female) sample of 100 primary care patients with a mean age of 38.62 (SD = 12.99). Fourteen primary care physicians also participated. As hypothesized, destructive overdependence and dysfunctional detachment scores were positively correlated with number of contacts with the emergency department; healthy dependency scores were inversely related to emergency department contacts and number of overnight hospitalizations. Healthy dependency scores were associated with an array of positive health behaviors; destructive overdependence scores were negatively associated with positive health behaviors. In addition, healthy dependency scores were inversely related to physician ratings of a difficult doctor-patient relationship. These results demonstrate that destructive overdependence, dysfunctional detachment and healthy dependency scores are associated in expected ways with indices of health and health-related behavior, and help illuminate the underlying factors that contribute to comparatively poor health and variations in health service use among overdependent and detached medical patients.

Convergence in patient and therapist alliance ratings early in treatment with Personality Assessment Inventory clinical scales and subscales.

We examined discrepancies in 81 patient-therapist dyads' alliance ratings early in treatment (3rd or 4th session) in relation to Personality Assessment Inventory clinical scales, subscales and global psychopathology. Results indicated that PAI global psychopathology (mean clinical elevation) and the scales of Aggression [AGG], Somatization [SOM], and Anxiety-Related Disorders [ARD] were significantly, negatively associated with an absolute difference of patient and therapist alliance ratings at Session 3. Higher initial scores on these clinical scales at treatment onset are associated with less difference (i.e., more convergence) in patient/ therapist ratings of alliance at Session 3. Correlations between PAI clinical subscales and absolute differences of patient and therapist alliance ratings at Session 3 also demonstrated statistically significant inverse relationships for several PAI subscales of Aggression- Attitude [AGG-A], Aggression-Physical [AGG-P], Somatic- Health Concerns [SOM-H], Anxiety-Related Disorders-Traumatic Stress [ARD-T], Anxiety-Related Disorders- Obsessive Compulsive [ARD-O], Borderline Features-Affective Instability [BOR-A], Borderline- Self-Harm [BOR-S], Anxiety-Physiological [ANX-P], Depression-Physiological [DEP-P] and Antisocial-Stimulus Seeking [ANT-S]. Again, higher scores on these subscales at treatment onset are associated with less difference (i.e., more convergence) in patient/therapist ratings. We also examined group differences between patients rating alliance higher (Group 1) and therapists rating alliance higher (Group 2) and found that Group 1 had significantly lower scores on Mania-Activity Level [MAN-A]. Clinical implications of results are discussed.

Context-Driven Variability in Personality and Interpersonal Behavior: Evidence-Based Assessment Strategies.

How can assessors capture context-driven variability in personality and interpersonal behavior in ways that are both empirically sound and clinically useful? Scott et al. (2021) offer one potential solution as they discuss the Relational Self-Schema Measure, designed to assess variations in the self-schema across different relationship domains (e.g., self-with-parents, self-with-friends). This Comment outlines an evidence-based framework for assessing variability in personality and interpersonal behavior, describing three strategies that may be used by practitioners in the clinic and beyond. These are: 1) complementing decontextualized personality test results with domain-specific self-report and performance-based test data; 2) employing ambulatory assessment techniques to capture contextual variations in responding in vivo; and 3) using nomothetic test results as a springboard for patient narrative, with patient and therapist working together to explore relationship-specific variations in personality and interpersonal behavior.

Italian Version of the Relationship Profile Test (RPT-I): Temporal Stability, Construct Validity, and Cross-Cultural Comparison.

This study presents the adaptation to the Italian context of the Relationship Profile Test (RPT; Bornstein & Languirand), a self-report measure of Destructive Overdependence (DO), Dysfunctional Detachment (DD), and Healthy Dependency (HD). The RPT was administered to a community sample of 661 nonclinical Italian adults together with the Attachment Style Questionnaire, the Relational-Interdependent Self-Construal Scale, the Rosenberg Self-Esteem Scale, the Self-Compassion Scale, the Positive Affect-Negative Affect Scale, and the Toronto Alexithymia Scale. A randomly selected subset of participants (n = 67) completed the RPT again approximately 5 months after the first administration. The factor structure of the RPT obtained in the main sample was compared with that obtained in a sample of 603 adult participants from the US and was found to be similar. Internal consistency for DO, DD, and HD scores in the Italian sample fell between the acceptable to good range, and test-retest reliability coefficients were all above .70. The three scales yielded the expected pattern of correlations with theoretically related constructs, documenting good criterion validity. Findings are discussed in light of the literature on the RPT as a measure of interpersonal dependency and detachment. Suggestions for future research are offered.

Personality assessment inventory items in relation to patient- and therapist-rated alliance.

Based on the results of prior research, we examined relationships between Personality Assessment Inventory (PAI) items on clinical scales of antisocial features (ANT) and anxiety-related disorders (ARD) with patient- and therapist-rated alliance early in treatment (third or fourth session). We also explored the relationship between the PAI treatment rejection scale (RXR) and early session therapist-rated alliance, despite null findings in previous work. We used PAI protocols from a clinical outpatient sample (N = 80). Data were analysed using backwards linear regressions. Results indicated that a group of ANT items from different ANT subscales predicted patient-rated therapeutic alliance, F(8,59) = 5.182, p = .000, R2 of .413, f2 = 0.70. Additionally, a group of ARD items from different ARD subscales significantly predicted therapist-rated alliance, F(6,62) = 3.007, p = .012, R2 of .225, f2 = 0.29. No significant relationships were found for RXR items and therapist-rated alliance, consistent with prior findings. Clinical implications are discussed.

The Effect of Donepezil on Problem-solving Ability in Individuals With Amnestic Mild Cognitive Impairment: A Pilot Study.

BACKGROUND: Clinical trials involving individuals with mild cognitive impairment (MCI) have reported mixed results for the effects of cholinesterase inhibitors on cognitive outcomes. Our previous work demonstrated that a visuospatial problem-solving task was sensitive to non-memory impairments in individuals with MCI. OBJECTIVE: To determine whether the same task is also sensitive to the effects of cholinesterase inhibitors in individuals with amnestic MCI (aMCI). METHOD: We gave 22 individuals with aMCI (clinical dementia rating of 0.5) and Mini-Mental State Examination (MMSE) scores of at least 24 the following measures at baseline and at follow-up 1 year later: Hopkins Verbal Learning Test, Boston Naming Test, Rey Complex Figures Test copying task, anagrams task, and visuospatial problem-solving task. The MMSE was also given at the 1-year follow-up. Twelve of the individuals were drug naïve, having never taken cholinesterase inhibitors before, and donepezil was initiated and titrated to 10 mg daily after baseline in an open-label manner. Ten of the individuals had already been taking donepezil, and there was no change in treatment. We compared the two groups for amount of performance change over 1 year. RESULTS: Individuals for whom donepezil was initiated performed significantly better on the visuospatial problem-solving task after 1 year compared with individuals who had already been taking donepezil. No difference was observed for any of the other variables. CONCLUSION: The visuospatial problem-solving task appeared to be more sensitive than memory measures to the effects of cholinesterase inhibitors in individuals with aMCI, perhaps due to the high attentional demand of the task.

Narcissism and Reactions to a Self-Esteem Insult: An Experiment Using Predictions from Self-Report and the Rorschach Task.

We used self-reported narcissistic grandiosity and vulnerability and a component derived from 11 potential grandiosity and narcissism variables (GNVs) coded from Rorschach behavior to predict fluctuations in self-esteem and their links to anger and defensive reactions. We assessed state mood, state self-esteem, and performance attributions in 105 college students who underwent a self-esteem manipulation involving success followed by failure on cognitive testing. Self-reported grandiosity predicted the disavowal of effortful ability as a factor in failure, but we did not replicate other previously reported findings for this variable. Self-reported vulnerability predicted oscillations in self-reported mood and self-esteem. The GNV scale predicted spontaneously expressed hostility and externalization following self-esteem insult, and attributions mediated its relationship with anger expressed after failure. We discuss implications of these results and recommend additional replication research.

From Structure to Process: On the Integration of AMPD and HiTOP.

In recent years the limitations of traditional categorical frameworks for conceptualizing and diagnosing psychopathology have become increasingly clear, prompting the development of dimensional models wherein psychological dysfunction is assessed on a series of continua. Two frameworks have been particularly influential: the Alternative Model for Personality Disorders (AMPD) outlined in DSM-5 (American Psychiatric Association, 2013 ), and the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017 ). Widiger et al.'s timely and insightful review addresses two key questions regarding AMPD and HiTOP: Do deficits in self- and interpersonal functioning (AMPD Criterion A) have incremental validity over maladaptive traits (Criterion B), and if so, should Criterion A be included in HiTOP? In this commentary I argue that to resolve these questions conclusively, studies of factor structure and construct covariation must be complemented by investigations that address three issues: (a) Are there identifiable causal links between Criterion A impairments and Criterion B traits; (b) Do salient life events, therapeutic interventions, and experimental manipulations differentially affect Criterion A and Criterion B scores; and (c) Do Criterion A and Criterion B scores predict different outcomes in laboratory, clinical, and field settings?

Beyond trait reductionism: Implications of network structures for dimensional models of psychopathology.

Borsboom et al. discuss the implications of network structures for neurobiology-based reductionism, but inherent in the network approach is that dimensional models of psychopathology are untenable as well. Insofar as mental disorders are complex dynamic constellations of symptoms, the "trait reductionism" of dimensional psychopathology frameworks suffers from the same limitations as neurobiological reductionism.

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.

Evidence-Based Psychological Assessment.

In recent years there has been increasing emphasis on evidence-based practice in psychology (EBPP), and as is true in most health care professions, the primary focus of EBPP has been on treatment. Comparatively little attention has been devoted to applying the principles of EBPP to psychological assessment, despite the fact that assessment plays a central role in myriad domains of empirical and applied psychology (e.g., research, forensics, behavioral health, risk management, diagnosis and classification in mental health settings, documentation of neuropsychological impairment and recovery, personnel selection and placement in organizational contexts). This article outlines the central elements of evidence-based psychological assessment (EBPA), using the American Psychological Association's tripartite definition of EBPP as integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. After discussing strategies for conceptualizing and operationalizing evidence-based testing and evidence-based assessment, 6 core skills and 3 meta-skills that underlie proficiency in psychological assessment are described. The integration of patient characteristics, culture, and preferences is discussed in terms of the complex interaction of patient and assessor identities and values throughout the assessment process. A preliminary framework for implementing EBPA is offered, and avenues for continued refinement and growth are described.

Relationship Between Patient SWAP-200 Personality Characteristics and Therapist-Rated Therapeutic Alliance Early in Treatment.

In the present study, we assess the extent to which patient personality features and prototypes are associated with early treatment therapist-rated alliance. The study sample consisted of 94 patients receiving psychodynamic psychotherapy at an outpatient clinic. Clinicians completed the Working Alliance Inventory (J Couns Psychol 36:223-233; Psychother Res 9:405-423) to assess their views of early alliance and the Shedler-Westen Assessment Procedure 200 (SWAP-200; Assessment 5:333-353, Am J Psychiatry 161:1350-1365, 1743-1754; Am J Psychiatry 156:258-272, 273-285) to assess patient personality. The SWAP-200 Narcissistic Clinical Prototype, Dysphoric Q-Factor, and Dysphoric/High-Functioning Neurotic Q-Subfactor significantly correlated with early therapist-rated alliance. Correlations that trended toward significance were also found. Also identified were specific SWAP-200 items that were found to relate to high early therapist-rated alliance scores. These results demonstrate some relationship, albeit small, between patient personality characteristics and therapists' views of the alliance that may serve to further a conceptual understanding of the alliance, specific personality syndromes, and the associated impact on the therapeutic interaction.

Construct Validity of the Relationship Profile Test: Links With Measures of Psychopathology and Adult Attachment.

This study assessed the construct validity of the Relationship Profile Test (RPT; Bornstein & Languirand, 2003 ) with a substance abuse sample. One hundred-eight substance abuse patients completed the RPT, Experiences in Close Relationships Scale-Short Form (Wei, Russell, Mallinckrodt, & Vogel, 2007 ), Personality Assessment Inventory (Morey, 1991 ), and Symptom Checklist-90-Revised (Derogatis, 1983 ). Results suggest that the RPT has good construct validity when compared against theoretically related broadband measures of personality, psychopathology, and adult attachment. Overall, health dependency was negatively related to measures of psychopathology and insecure attachment, and overdependence was positively related to measures of psychopathology and attachment anxiety. Many of the predictions regarding RPT detachment and the criterion measures were not supported. Implications of these findings are discussed.

The Relationship between Theoretical Orientation and Countertransference Expectations: Implications for Ethical Dilemmas and Risk Management.

UNLABELLED: Countertransference (CT) awareness is widely considered valuable for differential diagnosis and the proactive management of ethical dilemmas. We predicted that the more practitioners' theoretical orientation (TO) emphasizes insight into the dynamics of subjective mental life, the better they will be at using their CT expectations in differential diagnosis with high-risk patients. To test this hypothesis, we compared psychodynamic therapy (PDT) practitioners who emphasize insight into subjective mental life with practitioners who do not emphasize this epistemology. Results indicated that PDT practitioners expected significantly more CT than practitioners of cognitive-behavioural therapy (CBT) and other practitioners (e.g., family systems, humanistic/existential and eclectic) to patients with borderline personality organization overall. PDT practitioners had significantly more CT expectations to patients with borderline-level pathologies as compared with neurotic-level patients than both CBT and other practitioners. PDT practitioners were significantly more expectant of CT issues than CBT practitioners with respect to the personality disorders most associated with acting out and risk management problems (e.g., paranoid, psychopathic, narcissistic, sadistic, sadomasochistic, masochistic, hypomanic, passive-aggressive, counterdependent and counterphobic). The other practitioners generally had CT expectations between PDT and CBT. These findings suggest that clinical training into CT may be useful in differential diagnoses and in helping to avoid ethical dilemmas regardless of one's theoretical preference. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Insight into countertransference can be used to help with differential diagnoses and to help prevent possible management problems with acting out patients. The Psychodynamic Diagnostic Manual is a useful taxonomy in that it includes countertransference as a diagnostic aid.

The complex role of personality in cancer treatment: impact of dependency-detachment on health status, distress, and physician-patient relationship.

Personality traits have been associated with positive and negative adjustment to a cancer diagnosis. No studies have assessed trait dependency and detachment and their relationship to health, distress, and the doctor-patient relationship in patients undergoing radiation treatment for cancer. Fifty adults (32 women; mean [SD], 60.32 [12.74] years) undergoing radiation treatment for a variety of cancers completed measures of dependency and detachment, doctor-patient relationship, physical health, somatization, anxiety, and depression. Overdependence scores were positively and significantly correlated with patients' anxiety and negatively and significantly correlated with the physician-patient relationship. Detachment scores were positively and significantly correlated with pain, somatization, depression, and anxiety and marginally associated with lower health-related quality of life. These preliminary findings support the construct validity and clinical utility of trait dependency and detachment testing with oncology patients and suggest that detachment is associated with poorer quality of life and higher psychological distress, whereas dependency is associated with poorer doctor-patient relationships after a cancer diagnosis.

Toward a more nuanced conceptualization of interpersonal distancing: Differential relationships of adaptive and dysfunctional detachment to stress-based anxiety in college students.

This study investigates the utility of a model for disambiguating the risk vs. protective features associated with detachment in moderating stress-based anxiety. The model distinguishes adaptive detachment (the ability to engage in flexible, goal-directed cognitive distancing accompanied by the capacity to moderate affective arousal and maintain functional levels of interpersonal connectedness) from dysfunctional detachment (a more generalized detached interpersonal style characterized by pervasive social isolation and negative emotionality). College students (N = 104, 71.4% female, mean age = 19.20 (SD = 3.54)) completed measures of detachment, mental health symptoms, and daily hassles; moderator hypotheses were tested by conducting a series of regression analyses. Findings indicate that individuals who report higher levels of adaptive detachment-but not dysfunctional detachment-experienced reduced anxiety in the context of elevated daily stressors. Results suggest that certain aspects of detachment may serve protective functions by reducing anxiety in the context of stressful events.