Do Relational and Self-Definitional Traits Influence Deep Brain Stimulation Device Preference?

Personality psychodynamics have been shown to influence individual responses to psychiatric treatments, including medication. Increasingly, neuromodulation therapies have become available for severe and treatment-resistant depression. This study aims to evaluate patient response to an implanted neurostimulator battery within the framework of relational versus self-definitional personality traits. Relational development is interpersonally oriented and disruptions along this pathway lead to dependency on others for a sense of security and self-worth. Self-definitional development is characterized by autonomy strivings and disruptions lead to self-critical feelings of failing to meet expectations. Patients drawn from a larger study of deep brain stimulation (DBS) for treatment-resistant depression were switched from a non-rechargeable to a rechargeable battery type to maintain stimulation therapy. This switch entailed taking greater personal responsibility for device maintenance and allowed for fewer battery replacement surgeries. Twenty-six patients completed the Depressive Experiences Questionnaire (DEQ) and a questionnaire surveying their preference for DBS battery type. Results show that the DEQ dependency subscale, and more specifically the neediness component of the subscale, is associated with patient preference for the non-rechargeable battery. This suggests that individuals with higher relational needs prefer treatment options that increase contact with and need for medical caregivers and may prioritize this aspect of an intervention over alternative considerations. In contrast, individuals with more self-critical personality traits did not have a battery type preference, indicating that self-definitional needs were not predictive of battery preference. The link between an individual's personality psychodynamics and response to biomedical interventions, including neuromodulation and treatments that incorporate medical devices, deserves further attention.

The Anaclitic-Introjective Depression Assessment: Development and preliminary validity of an observer-rated measure.

BACKGROUND: The two-configurations model developed by Blatt and colleagues offers a comprehensive conceptual and empirical framework for understanding depression. This model suggests that depressed patients struggle, at different developmental levels, with issues related to dependency (anaclitic issues) or self-definition (introjective issues), or a combination of both. AIMS: This paper reports three studies on the development and preliminary validation of the Anaclitic-Introjective Depression Assessment, an observer-rated assessment tool of impairments in relatedness and self-definition in clinical depression based on the item pool of the Shedler-Westen Assessment Procedure. METHOD: Study 1 describes the development of the measure using expert consensus rating and Q-methodology. Studies 2 and 3 report the assessment of its psychometric properties, preliminary reliability, and validity in a sample of 128 patients diagnosed with treatment-resistant depression. RESULTS: Four naturally occurring clusters of depressed patients were identified using Q-factor analysis, which, overall, showed meaningful and theoretically expected relationships with anaclitic/introjective prototypes as formulated by experts, as well as with clinical, social, occupational, global, and relational functioning. CONCLUSION: Taken together, findings reported in this paper provide preliminary evidence for the reliability and validity of the Anaclitic-Introjective Depression Assessment, an observer-rated measure that allows the detection of important nuanced differentiations between and within anaclitic and introjective depression.

Assessing Anaclitic and Introjective Characteristics Using the SWAP-200 Q-Sort: Concurrent Validity with the Inventory of Interpersonal Problems Circumplex Scales.

This investigation's goal was to assess the concurrent validity of the four scales of the Anaclitic and Introjective Depression Assessment (AIDA), a newly developed clinician-rated measure, and the Inventory of Interpersonal Problems Circumplex Scales (IIP-64). The AIDA is composed of Shedler-Westen Assessment Procedure items and is comprised of two primitive and two more mature scales of introjective and anaclitic personality types. Specific predictions of relationships were made and are discussed further in this paper. The participants in this study were 106 outpatients engaged in psychodynamic psychotherapy. Patients completed the IIP-64 upon assessment and were rated by their therapist on the Shedler-Westen Assessment Procedure 200 (SWAP-200). The present findings demonstrated several expected relationships between the SWAP-derived AIDA and the IIP-64. Primitive levels of Anaclitic and Introjective characteristics on the AIDA were related to more difficulties involving Affiliation and Dominance on the IIP. The primitive Introjective-Dismissive (Dismissive Depression) scale was related to difficulties involving high Dominance and low Affiliation. The more adaptive Introjective-Self-Critical (Self-Critical Depression) scale was not related to any interpersonal problem. The more adaptive Anaclitic-Needy (Needy Depression) scale was related to difficulties involving high Affiliation, and the primitive Anaclitic-Submissive (Submissive Depression) scale was associated with difficulties related to high Affiliation, as well as problems related to low Dominance in one of two domains. Our results bolster the concurrent validity of the four AIDA scales and add to current knowledge of the differential interpersonal patterns of individuals with more mature and primitive levels of anaclitic and introjective personality types. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Clinicians can utilize the Anaclitic and Introjective Depression Assessment (AIDA; Rost, Fonagy, & Luyten, 2014), derived from Shedler-Westen Assessment Procedure (SWAP) items, to assess if their patients possess Anaclitic or Introjective characteristics. This measure can also be used to assess if the Anaclitic and Introjective characteristics are of a more primitive or mature nature. Clinicians should be aware that individuals with more primitive levels of Anaclitic and Introjective characteristics experience more difficulties involving Affiliation and Dominance than individuals with more mature levels of personality development. Specifically, the more primitive Introjective individual will likely encounter difficulties involving high Dominance and low Affiliation. The more adaptive Introjective individual will likely not demonstrate difficulties in these areas. The more primitive Anaclitic individual will likely encounter more difficulties related to high Affiliation, as well as problems related to low Dominance. The more adaptive Anaclitic individual also likely will encounter difficulties involving high Affiliation.

Quality of Internalized Object Representations and Suicidality in Individuals With Anaclitic and Introjective Personality Styles.

Research has shown differences in the characteristics of suicidal behavior in individuals with dependent (anaclitic) versus self-critical (introjective) personality styles. Questions remain, however, as to what factors distinguish suicidal from nonsuicidal individuals within each personality style. The current study examined clinical and interpersonal correlates of suicidality in 124 patients attending residential treatment for complex psychiatric disorders, with the aim of clarifying how social cognition and quality of internalized object representations relate to suicidality in individuals with anaclitic versus introjective personality organizations. Higher anaclitic and lower introjective traits each predicted higher frequency of prior attempts. Furthermore, higher anaclitic and lower introjective traits interacted with the affective-interpersonal quality of object representations to predict prior attempts, such that each trait was associated with more frequent past attempts in the context of poorer quality of object relations. The treatment implications of these findings are discussed, and areas for future research are considered.

Countertransference Processes in Psychodynamic Therapy with Dependent (Anaclitic) Depressed Patients: A Qualitative Study Using Supervision Data.

Although Blatt's two-polarity model of depression has suggested that patients' interpersonal styles may shape countertransference phenomena in psychotherapy, empirical research on this topic has remained scarce. This article provides an in-depth study of countertransference processes in clinical work with dependent (anaclitic) depressed patients using a qualitative methodology. Thematic analysis of narrative material of psychodynamic therapists discussing patient cases during supervision (n = 7) resulted in four recurrent themes: "empathy, compassion, and support," "anxiety, feeling overwhelmed, and protection," "frustration, irritation, and confrontation," and "inadequacy, incompetence, and fatalism." We found that these countertransference processes mainly revolved around perceived adaptive and maladaptive aspects of patients' relational functioning. Regarding clinical practice, our study suggests that therapists can use countertransference to determine in which position they are maneuvered by patients, although we caution against the exclusive use of subjectively informed data as a benchmark in the diagnostic and treatment process. We conclude that further in-depth research on countertransference and personality styles is needed to identify pitfalls in the treatment of depression.

Assessing Personality Change with Blatt's Anaclitic and Introjective Configurations and Shedler-Westen Assessment Procedure Profiles: Two Case Studies in Psychodynamic Treatment.

A growing body of empirical and clinical research attests to the influence of personality features on the development, course and outcome of psychotherapy. Over the last four decades, Blatt adopted a psychoanalytic and cognitive developmental approach in developing a theoretically and empirically grounded two-configurations model of personality. The main aim of this study was to evaluate possible changes in anaclitic and introjective configurations - as measured by the Depressive Experience Questionnaire (DEQ) (Blatt, D'Afflitti, & Quinlan, 1976) - set against simultaneous changes in personality profile measured by Shedler-Westen Assessment Procedure (SWAP-200). Two young patients, a man and a woman, characterized by different personality profiles - introjective and anaclitic, respectively - were assessed for one year in the context of a psychodynamic psychotherapy. A battery of instruments - Beck Depression Inventory II (BDI-II), Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders I and II, Defense Mechanism Rating Scale, DEQ and SWAP-200 - were administered at the beginning, during the assessment process, and after one year. Both patients displayed lower BDI-II scores, along with evident clinical progress. Defence profiles and Core Conflict Relationship Themes showed interesting developments, in keeping with the evolution of the psychotherapy process. Lastly, while DEQ profiles outlined substantial stability after one year, some important changes in SWAP-200 profiles - in particular with regard to Q factors - were observed. Although these findings should be considered as preliminary, these results appear to be consistent with the description of Self-criticism and Dependency as relatively stable personality dimensions. The potential influence of profile diversity - introjective vs anaclitic - on other key variables of the psychotherapy process is also discussed.

El objeto a en la perversión / The objet a in the perversion

En el presenta trabajo abordamos la función del objeto a en la perversión. Intentaremos ubicar, de éste modo, la oposición entre neurosis y perversión como dos modos, fundamentalmente distintos, de posicionarse frente a la falta en el Otro y al plus del goce. Por esta vía trataremos de despejar la definición del perverso como instrumento del goce del Otro.

In this work we tackle the function of the objet a in the perversion. We try to know the opposition between neurosis and perversion as two very differents positions faced with the Other's fault and the plus of jouissance. We also try to demarcate the definition of perversion as an instrument of the Other's jouissance.

Contraposición del concepto de tipo anaclítico de elección de objeto en Freud y Lacan / Contrast of the anaclitic object-choice concept in Freud and Lacan

Este trabajo articula el concepto freudiano de elección de objeto de tipo anaclítico con el concepto lacaniano de relación anaclítica, examinando sus relaciones, semejanzas y diferencias. En primer lugar, se delimita el concepto freudiano, se subraya la complejidad de sus relaciones con otros conceptos de la teoría de Freud, y se destaca las dificultades de comprensión en los desarrollos posfreudianos, derivadas de esa complejidad. En segundo lugar, se delimita el concepto lacaniano, o más bien, los dos conceptos de relación anaclítica que Lacan elabora en momentos distantes de su obra. Uno, en el Seminario 4, donde construye ese concepto sobre el eje del erotismo y la intersubjetividad, excluyendo los componentes de las pulsiones yoicas (núcleo del concepto freudiano). Otro, en el Seminario 16, donde la relación anaclítica queda ubicada como característica esencial de la estructura perversa en oposición a la relación narcisista, propia de la neurosis.

This work articulates the Freudian concept of Anaclitic Object-Choice with the Lacanian concept of Anaclitic Relation by examining their relations, similarities and differences. First, the Freudian concept is delimited and the complexity of its relations to other concepts of the Freudian theory is highlighted, pointing out the difficulties in understanding post-Freudian developments stemming from such complexity. Secondly, the Lacanian concept is delimited, or rather both concepts of anaclitic relation developed by Lacan in different moments of his work are described. The first concept, presented in Seminar 4, Lacan builds a concept over the eroticism and intersubjectivity axis, excluding the id's drives components (the core of the Freudian concept). The other concept is presented within Seminar 16, where the anaclitic relation is considered an essential characteristic of the perverse structure in opposition to the Narcissistic relationship, which is typical of neurosis.

Psicopatologia da carência afetiva do bebê: a depressão anaclítica / Psychopathology of the infant's affective lack: the anaclitic depression

Objetivo: elaborar material bibliográfico atualizado acerca da depressão anaclítica. Método: pesquisa bibliográfica. Discussão: a privação de relações objetais no primeiro ano de vida é um fator prejudicial, que desencadeia sérios transtornos emocionais, a exemplo da depressão anaclítica. Trata-se de uma síndrome depressiva que ocorre em bebês entre o sexto e oitavo mês de vida, cuja etiologia é decorrente de um estado de privação materna, da perda de um laço privilegiado com a mãe ? ou com o cuidador que exerça a função materna ? e do suporte que esta representava para o bebê. Considerações finais: a análise da literatura consultada reforça a relevância da figura materna como fonte vital à saúde física e emocional do bebê. Busca-se com este estudo orientar profissionais e cuidadores a reconhecer a acuidade do sofrimento psíquico em bebês e suas implicações no desenvolvimento.

Objective: to elaborate bibliographical material modernized concerning the anaclitic depression. Method: bibliographic research. Discussion: the privation of the objects relations in the first year of life is a harmful factor, that can develop serious affective disorders, as anaclitic depression. This is a depressive syndrome that affect infants between the age of six and eight month, its etiology is due to a state of maternal privation, to the loss of a privileged relation with the mother ? or a caregiver who exercise the maternal function ? and of the support that she represented for the infant. Final consideration: the analysis of the consulted literature reinforces the relevance of the maternal figure as a vital source to the infant?s physical and emotional health. With this study we looked for guiding professionals and caregivers to recognize the gravity of the psychic suffering in infants and its implication of the development