Intuition and meaning in life in persons with varying level of depressive symptoms and impairments in personality functioning

Culture and ICD-11 personality disorder: Implications for clinical practice across diverse ethnic groups

BACKGROUND

Personality disorder (PD) in ICD-11 is defined primarily by self and interpersonal dysfunction and optionally by other qualifiers. This definition is inseparable from relativism of cultural determinants.

AIMS

This review aimed to synthesize the relevant aspects of the influence of culture on clinical practice and health management for this condition, aligning them to the ICD-11 PD model.

METHOD

In Scopus, we systematically searched for studies that included the text strings: cultur* | personality AND (disorder* OR patholog*) without any restrictions on publication date or language or other exclusion criteria, up to November 2022.

RESULTS

Evidence suggests that cultural variables in ethnic groups (Western and non-Western) such as the individualist/collectivist philosophy, historical/generational trauma, immigration, acculturation, religion, and gender influence the etiology, semiology, epidemiology, evaluation, diagnosis, treatment, and management of health services for ICD-11 PD. We discuss the limitations and propose future lines of research on this topic based on our knowledge and experience. In this review, we provide the scientific community and clinicians with relevant cultural information to guide their practice and propose strategies to manage PD from the ICD-11 model.

CONCLUSIONS

More research is needed using mixed study methodologies on stigma, the experiences of patients, clinicians, and health agencies, to reduce the care gaps and achieve a culturally comprehensive, inclusive, and competent use of this new model.

Meaning in Life as an Outcome of Inpatient or Day-Hospital Psychotherapy for Personality Disorder

Psychotherapy may contribute to the experience of meaning in life. This study investigated meaning in life among patients with personality disorders during inpatient or day-hospital psychotherapy. Meaning in life was approached from two conceptual perspectives: personality functioning with an emphasis on self-direction and existential psychology. We investigated changes in the sense of meaning in life and accounted for changes in depressive symptoms and identity and interpersonal pathology. Using pre-post measures, Livesley's General Assessment of Personality Disorder, especially, the Lack-of-Meaning-Purpose-and-Direction subscale and Steger's Meaning-in-Life Presence subscale were administered to 75 patients with personality disorders during inpatient or day-hospital psychotherapy for 8-12 months. Regression models showed that levels of the lack and presence of meaning decreased and increased during treatment, respectively, controlled for changes in depressive symptoms. Decreased identity pathology was significantly associated with changes in the lack or presence of meaning. Meaning in life may act as an outcome variable in intensive psychotherapy for personality disorders. The development of identity and self-direction may restore or create the ability to give life meaning.

Longitudinal Associations of Experiential and Reflective Dimensions of Meaning in Life With Psychopathological Symptoms

Background

Rather than being rooted in deliberate reflection, the experience of meaning has been shown to evolve from intuitive processes (Heintzelman & King, 2013b, https://doi.org/10.1007/978-94-007-6527-6_7). Accordingly, experiential and reflective dimensions of meaning in life can be distinguished (Hill et al., 2019, https://doi.org/10.1080/09515070.2018.1434483). In this preregistered study, we explored how these dimensions are longitudinally associated with psychopathological symptoms. We expected that experiencing more meaning would predict fewer depressive symptoms and fewer personality functioning impairments six months later, whereas reflecting about meaning would predict more psychopathological symptoms.

Method

A German-speaking sample of N = 388 completed self-report measures assessing meaning in life, depression, and personality functioning at baseline and six months later.

Results

Controlling for depression at baseline, elevated levels of experiencing meaning in life predicted a decrease in depressive symptoms. Experiencing meaning did not predict personality functioning impairments six months later. However, exploratory analyses with a larger sample tentatively showed that experiencing meaning in life predicted less impairments in personality functioning. Evidence supporting the hypothesized association between reflection and future depression as well as future personality functioning impairments was discerned through exploratory analyses. Generalizability of results to clinical care settings is limited due to the studied non-clinical sample. No causal conclusions can be drawn from the data because the study employed an observational design with two assessment points.

Conclusion

Experiencing meaning in life emerged as a potential protective factor against future psychopathological symptoms, whereas exploratory analyses pointed to an opposite relationship for reflection about meaning in life. Results are discussed with regard to clinical implications and directions for future research.

Temporal associations between meaning in life, ultimate meaning struggles, and mental health outcomes in a spiritually integrated inpatient program

BACKGROUND

Meaning in life is a benchmark indicator of flourishing that can likely mitigate the severity of depression symptoms among persons seeking mental healthcare. However, patients contending with serious mental health difficulties often experience a painful void or absence of ultimate meaning in their lives that might hinder recovery. This two-wave longitudinal study examined temporal associations between perceived presence of meaning in life, struggles with ultimate meaning, flourishing, and depression symptoms among adults in a spiritually integrated inpatient treatment program.

METHODS

Of the 242 patients assessed at intake, 90% (N = 218; 40% Cisgender male; 57% Cisgender female; 3.0% nonbinary) completed validated measures of these meaning-related factors and mental health outcomes at discharge.

RESULTS

Cross-sectional analyses revealed perceptions of meaning in life and ultimate meaning struggles were inversely linked with one another along with being associated with indices of positive and negative mental health in varying ways at the start and end of treatment. Drawing upon a two-wave cross-lagged panel design, longitudinal structural equation modeling analyses supported a Primary Meaning Model whereby having a subjective sense of meaning in life at intake was prospectively linked with lower levels of ultimate meaning struggles and greater flourishing at discharge. However, baseline levels of mental health outcomes were not predictive of the meaning-related factors in this sample.

CONCLUSION

Findings highlight the utility of assessing patients' perceived meaning in life and ultimate meaning struggles in spiritually integrated programs and for clinicians to be prepared to possibly address these meaning-related concerns in the treatment process.