Narrative identity in female patients with remitted bipolar disorder: a negative past and a foreshortened future

Development and Validation of the Narrative Identity Self-Evaluation Scale (NISE)

In narrative identity research, variables are typically captured through detailed content-coding of personal narratives. Yet, alternative methods have been suggested, notably self-report scales, because they capture a participant's own interpretation of their personal narratives, and because they are efficient to administer as a supplement to more labor-intensive coding methods. This study developed and validated the Narrative Identity Self-Evaluation (NISE) questionnaire. In Study 1, the questionnaire was developed through exploratory factor analysis (n = 425) and its criterion validity examined. In Study 2, the NISE factor structure and criterion relationships were confirmed (n = 304). In Study 3 (based on the same sample as Study 1), content-coding of 11 narrative identity characteristics in open-ended personal story accounts was conducted, and NISE scores were compared to corresponding content-coded variables. The 20-item NISE has three factors replicating common dimensions in narrative identity (autobiographical reasoning, desire for structure, positive motivational/affective themes) and a novel fourth factor capturing disturbances of narrative identity. The NISE correlated in theoretically-coherent ways with content coded narrative identity variables, self-report traits, and measures relevant for narrative identity, self-concept, well-being, and psychopathology. We discuss the scale's advantages in complementing content-coding of narrative accounts to assess variation in narrative identity within both clinical and non-clinical populations.

Mental illness and personal recovery: A narrative identity framework

This article presents a metamorphic model to describe the manifold role of narrative identity, a person's internal life story, across the course of mental illness and personal recovery. First, early adversity and negative co-authoring may contribute to the development of a fragile life story, which itself may combine with life stressors to increase the likelihood of mental illness. Second, mental illness may negatively impact the development of narrative identity, which in turn may exacerbate the devastating effects of mental illness on daily functioning. Finally, positive changes in narrative identity, as they are influenced by recovery stories of peers and the supportive co-authorship provided by mental health professionals, may contribute in powerful ways to the process of personal recovery. In sum, the metamorphic model demonstrates how narrative identity, as it is implicated in a variety of social spheres, shapes and is shaped by the course of mental illness and recovery. We also show how the model differs from other personality-oriented theories of psychopathology and how it may guide future research and interventions.

Illness and narrative identity: examining past and future life story chapters in individuals with bipolar disorder, diabetes mellitus or no chronic illness

The purpose of this study was to investigate whether narrative identity challenges are specific to Bipolar Disorder (BD) as a mental illness or a reflection of living with chronic illness. Nineteen individuals diagnosed with BD, 29 individuals diagnosed with Type 1 Diabetes Mellitus (T1DM) and 25 controls without chronic mental or somatic illness identified past and future life story chapters which were self-rated on emotional tone and self-event connections and content-coded for agency and communion themes. Individuals with BD self-rated their past chapters as more negative and less positive, and their chapters were lower on content-coded agency and communion themes compared to T1DM and controls. There were fewer group differences for future chapters, but BD was associated with lower self-rated positive emotional tone and self-stability connections as well as lower content-coded agency and communion themes. The results indicate that narrative identity is affected in individuals with BD above and beyond the consequences of living with chronic illness. This may reflect distinct effects of mental versus somatic illness on narrative identity.

Family relationships as a source of narrative identity of people with advanced dementia

BACKGROUND

The growing body of research on narrative identity, while helpful, rarely focuses on people with dementia. In this paper, we explore how individuals living with advanced dementia construct their narrative identities in relation to their family experiences, which play a crucial role in shaping identity as shown by recent studies.

METHODS

We conducted a qualitative study using data from 15 semi-structured interviews with people aged 66 to 94 who have advanced dementia. The data were analyzed using a textual-oriented discourse analysis.

RESULTS

We identified two discourses-autobiographical and economic-that organize their narrative identities. Through the autobiographical discourse, participants emphasized their sense of belonging within a social group and their role as custodians of family identity. Within the economic discourse, they negotiated their social utility and value, particularly in response to demeaning discourses targeting individuals who do not accumulate wealth. In the structural analysis, we identified two narrative types-looped or unfolding-that depend on their affective experiences related to their family. We especially explored how the repetition of narrative threads by individuals with dementia might indicate a traumatic background rather than just memory disruptions.

CONCLUSIONS

This study provides insights into the narrative identities of individuals with advanced dementia, shedding light on the intersection of family experiences and identity formation in this population.

Preliminary Steps Toward Extracting the Specific Alternative Model for Personality Disorders Diagnoses From Criteria A and B Self-Reports

The Alternative DSM-5 Model for Personality Disorders (AMPD) retains six specific personality disorders (PDs) that can be diagnosed based on Criterion A level of impairment and Criterion B maladaptive facets. Those specific diagnoses are still underresearched, despite the preference expressed by most PD scholars for a mixed/hybrid classification. This study explores the possibility of using Criterion A and B self-report questionnaires to extract the specific AMPD diagnoses. Plausible prevalence estimates were found in three samples (outpatient PD, private practice, community; N = 766) using the facet score ≥ 2 and t score > 65 methods for determining the presence of a Criterion B facet; diagnoses had meaningful correlations with external variables. This study provides evidence-albeit preliminary-that the extraction of the specific AMPD PDs from self-report questionnaires might be a viable avenue. Ultimately, it could promote the use and dissemination of those diagnoses for screening purposes in clinical and research settings.

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.

"My life disappeared in illness": bipolar disorder and themes in narrative identity

Bipolar Disorder (BD) has substantial consequences for the course of life and the formation of self and identity. In the present study, we extended the existing literature by examining narrative identity. Fifteen female outpatients with remitted BD and fifteen non-clinical control participants described past and future chapters in their life stories. The chapters were coded for agency, communion, redemption and contamination. Patients diagnosed with BD described their past chapters with lower agency, lower communion and more contamination compared to the control group. Contrary to our expectations, the future chapters described by the BD patients did not differ significantly from the control group. A focus on narrative identity may contribute to understanding the disorder and inspire interventions targeting personal recovery.

The relation between self-event connections and personality functioning in youth with severe psychopathology

Objective

One way in which individuals construct their narrative identity is by making self‐event connections, which are often linked to better functioning. Being unable to make connections is related to identity discontinuity and psychopathology. Work in the general population corroborates this association, but also highlights the importance of focusing on specific aspects of these connections and on vulnerable populations.

Method

We examined the association of self‐event connections with personality functioning in youth with severe psychopathology (cross‐sectional N = 228, M_age = 19.5, longitudinal N = 84), and the role of event and connection valence in the subsample of youth who made a connection (n = 188 and n = 68). Negative affectivity was controlled for in all models.

Results

We found no evidence that self‐event connections, nor connection valence and its interaction with event valence, are related to functioning. Positive event valence was associated with better functioning. Higher negative affectivity was strongly linked to lower functioning and explained the relation between event valence and functioning. No longitudinal associations emerged.

Conclusions

These findings show that for youth with severe psychopathology making self‐event connections may not be associated with better functioning. Moreover, negative affectivity may be a distal predictor of both event valence and functioning.

Differential diagnosis of borderline personality disorder and bipolar disorder: Self-concept, identity and self-esteem

Symptoms of borderline personality disorder (BPD) and bipolar disorder (BD) often overlap. In some cases, it is difficult to conduct a differential diagnosis based only on current diagnostic criteria Therefore, it is important to find clinical factors with high discriminatory specificity that, used together with structured or semi-structured interviews, could help improve diagnostic practice. We propose that a clinical analysis of identity, self-concept and self-esteem may help distinguish the two disorders, when they are not co-morbid. Our review of the studies that analyse these constructs in BD and BPD, separately, points in the direction of qualitative differences between the two disorders. In BPD, there is a well-documented identity diffusion, and the self-concept appears predominantly negative; shifts in self-concept and self-esteem are often tied to interpersonal triggers. In BD, patients struggle with their identity, but narrative identity might be less compromised compared with BPD; the shifts in self-concept and self-esteem appear more linked to internal (i.e. mood and motivational) factors. We end the paper by discussing the implications for clinicians and ideas for future comparative research.

Narrative Identity in Psychopathology: A Negative Past and a Bright but Foreshortened Future

We examined narrative identity as a possible transdiagnostic marker of psychopathology by interviewing individuals with schizophrenia, individuals with depression and a nonclinical control group about past and future chapters in their life stories. Participants were 20 patients with schizophrenia, 20 patients with depression, and 20 nonclinical control participants matched on age, gender, and education. Participants described up to 10 chapters in their past and future life stories and self-rated chapters on emotional tone and self-event connections. In addition, cognitive function and current levels of symptoms was assessed. Both patient groups self-rated their past chapters as more negative and less positive compared to the control group, but did not differ from each other. There were no group differences in positivity of future chapters, but both patient groups identified fewer future chapters with shorter temporal projections. The results are consistent with the notion that negative past aspects of narrative identity are a transdiagnostic marker of psychopathology, while also suggesting that individuals with mental illness construct a positive future, which may support hope.