The dependent personality and interpersonal problems

Narcissistic and dependent traits and behavior in four archetypal 2-person, 2-choice games

Introduction

The characteristic behaviors we use to define personality pathology arise from specific interpersonal interactions. In an effort to create a laboratory-based context in which behavior might be expected to be influenced by particular personality traits, we used four 2-person, 2-choice games (the Prisoner's Dilemma, Chicken, Leader, and Hero games) to create a simulated interaction and focused specifically on narcissism and dependency.

Method

An online sample of 1137 (35% male, M age = 38.46 years, SD age = 13.20) participants completed brief, self-reported measures of trait narcissism and dependency and played one of the four games. Before deciding how to act or react, participants received either no message, a promise to cooperate, or a threat to defect from a (confederate) partner.

Results

When receiving no message, those who cooperated in the Prisoner's Dilemma had lower trait narcissism, while those who defected in the Chicken and Leader games had higher trait narcissism. Also with no message, participants who cooperated in the Hero game had higher trait dependency. Promises only affected the relationship between trait narcissism in the Leader game while threats only affected the relationship between trait dependency in the Chicken game.

Discussion

These findings add to the limited behavioral research on personality pathology and largely support established interpersonal conceptualizations and models. Future work might extend these findings using even more ecologically valid approaches to explore the behavioral correlates of personality traits that have important implications for interpersonal interactions.

The prevalence and severity of loneliness and deficits in perceived social support among who have received a 'personality disorder' diagnosis or have relevant traits: a systematic review

BACKGROUND

Loneliness and struggles with unmet social needs are a common experience among people with 'personality disorder' diagnoses/traits. Given the impact of loneliness and poor perceived social support on mental health, and the importance of a sense of belonging for recovery, a systematic review examining the prevalence/severity of loneliness and deficits in perceived social support among people with 'personality disorder' diagnoses/traits is an essential step towards developing an intervention targeting the social needs of people with diagnoses/traits 'personality disorder'. Despite an extensive literature on loneliness and deficits of perceived social support among people with 'personality disorder' diagnosis/traits, to date there has been no systematic review of this evidence.

METHOD

We conducted a systematic review synthesising quantitative data on the prevalence/severity of loneliness and deficits of perceived social support among people with diagnoses/traits of 'personality disorder' in comparison with other clinical groups and the general population. We searched Medline, Embase, PsycINFO, Web of Social Science, Google scholar and Ethos British Library from inception to December 2021. We conducted quality appraisals using the Joanna Briggs Critical appraisal tools and rated the certainty of evidence using the Grading of Recommendation, Assessment, Development and Evaluation approach. A narrative synthesis was used describing the direction and strength of associations prioritising high quality studies.

FINDINGS

A final set of 70 studies are included in this review, most of which are cross-sectional studies (n = 55), based in the United States (51%) and focused on community samples. Our synthesis of evidence found that, across all types of 'personality disorders' (except 'narcissistic personality' traits), people with traits associated with 'personality disorder' or meeting criteria for a diagnosis of 'personality disorder', have higher levels of loneliness, lower perceived relationship satisfaction, and poorer social support than the general population or other clinical samples.

CONCLUSION

The quality of evidence is judged as low quality. However, given the distressing nature of loneliness and the known negative effects of loneliness on mental health and recovery, it is important for future research to explore mechanisms by which loneliness may exacerbate 'personality disorder' symptoms and the impact this has on recovery.

Loneliness in Personality Disorders

PURPOSE OF REVIEW

Loneliness is a common experience in patients with personality disorders (PDs) that are characterized by impairment in self (identity, self-direction) and interpersonal functioning (empathy, intimacy). Here, we review studies assessing the association of loneliness with PD or PD traits including DSM-5's Alternative Model of PD (AMPD).

RECENT FINDINGS

The number of loneliness studies varied greatly among different PDs with most studies conducted in borderline PD. Across PDs, loneliness was associated with the severity of psychopathological symptoms and with several AMPD trait domains. Consequently, loneliness may contribute to PD severity and further impair personality functioning. Loneliness and PD share intra- and interpersonal factors (i.e., increased rejection sensitivity, information processing biases, social withdrawal) and common origins in childhood maltreatment that may explain their close association. Future research needs to investigate mechanisms on how loneliness and core characteristics of PD mutually reinforce each other in order to therapeutically address loneliness in PD.

Psychotherapy of Dependent Personality Disorder: The Relationship of Patient-Therapist Interactions to Outcome

So far, only a few studies have focused on psychotherapy for Dependent Personality Disorder (DPD). DPD is marked by a repetitive pattern of efforts aiming at maintaining close relationships, which may present as a lack of assertiveness and as a difficulty in making routine decisions. The present study aims at exploring processes of change taking place during the working phase of a clarification-oriented psychotherapy (COP) by focusing on the in-session patient-therapist interaction, as it changes during treatment and their links with treatment outcome. Methods: N = 74 patients with DPD were recruited in a naturalistic setting; they underwent long-term COP. Sessions 15, 20 and 25 were video- or audio-recorded and analyzed using the Process-Content-Relationship Scale, an observer-rated instrument that measures the quality of the interaction processes from patient's and therapist's perspectives. Therapy outcomes were assessed with the Personality Inventory - Dependency Subscale, Beck Depression Inventory, Inventory of Interpersonal Problems and Self-efficacy Scale at intake and discharge of therapy. Three-level Hierarchical Linear Modeling was applied to test the hypotheses. Results: Improvement in interaction processes was observed in all patient's and therapist's variables over the sessions 15, 20, 25. Overall, this increase in quality of interaction process was unrelated with outcome, but decrease in dependency traits was predicted by increase in therapist's quality of relationship offer, understanding of content and directivity over the course of the working phase of COP. Conclusions: Studying interaction processes in DPD provides an initial understanding of differential roles of potential mechanisms of change in effective treatment.

Dependency Traits, Relationship Power, and Health Risks in Women Receiving Sexually-Transmitted Infection Clinic Services

In prior research, having traits consistent with a personality disorder has been shown to be related to substance use and high-risk sexual activity; however, few studies have examined relationships between dependency traits and health-jeopardizing behaviors. Individuals with traits consistent with dependent personality disorder may be more likely to be in a primary relationship characterized by unhealthy conditions, including physical abuse from a partner, low assertiveness in sexual situations, and partner infidelity. In addition, dependency traits may be associated with unhealthy coping (e.g., through substance use). To examine associations between dependent personality traits and these types of health-related behaviors, 198 women seeking sexually transmitted infection clinic services completed a computer-assisted assessment of dependent personality traits, substance use, unhealthy conditions in primary relationships, perceived sexual and relationship power, and sexual risk related to condom use. Dependency trait scores were correlated with the use of cocaine, heroin, and methamphetamine. Participants high in dependency traits reported low perceived power within their relationships and less say in sexual behaviors, including condom use. In a series of multivariate analyses, dependency traits significantly predicted having been hit by a partner, staying with a partner after he cheated, having sex because of threats, and fear of asking a partner to use a condom. Dependency traits were also associated with lower past condom use and lower future condom use intentions. Results suggest that dependent personality traits may place women at higher risk for physical abuse and harmful health behaviors.

I get so lonely, baby: The effects of loneliness and social isolation on romantic dependency

Individuals lacking fulfilling interpersonal interactions may experience feelings of loneliness. Consequently, these individuals may over-rely on their romantic partners to fulfill the need to belong. This study examined the effects of loneliness and social isolation on dependency on a romantic partner in a sample of college students (N = 104). Participants who were in a romantic relationship completed measures of loneliness, social isolation, and romantic dependency near the beginning of the semester (Time 1) and approximately 6 weeks later toward the end of the semester (Time 2). Toward the beginning of the semester, there were no significant predictors of dependency. Toward the end of the semester, individuals who reported higher social isolation reported higher levels of dependency. Time 1 dependency also predicted Time 2 dependency. Future methodological directions and suggestions regarding the examination of perceptions of loneliness and relationship expectations are discussed.

Illuminating a neglected clinical issue: societal costs of interpersonal dependency and dependent personality disorder

OBJECTIVES

To determine the degree to which patients with high levels of trait dependency or dependent personality disorder (DPD) engage in behaviors that harm themselves and others (e.g., domestic violence, child abuse).

METHOD

Six domains of literature were reviewed: (a) dependency as a risk factor for physical illness; (b) health care utilization and expenditures; (c) global and domain-specific functional impairment; (d) violence toward others; (e) victimization by others; and (f) self-harm.

RESULTS

High levels of trait dependency and DPD are associated with elevated risk for physical illness, partner and child abuse, and suicidality, as well as with high levels of functional impairment and increased health care expenditure.

CONCLUSIONS

Contrary to clinical lore, trait dependency and DPD are associated with behaviors that lead to myriad negative consequences for the dependent person, those close to them, and society as a whole. These patterns have noteworthy implications for assessment and treatment of dependent patients and suggest that DPD should be included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition.

From Dysfunction to Adaptation: An Interactionist Model of Dependency

Contrary to clinical lore, a dependent personality style is associated with active as well as passive behavior and may be adaptive in certain contexts (e.g., in fostering compliance with medical and psychotherapeutic treatment regimens). The cognitive/interactionist model conceptualizes dependency-related responding in terms of four components: (a) motivational (a marked need for guidance, support, and approval from others); (b) cognitive (a perception of oneself as powerless and ineffectual); (c) affective (a tendency to become anxious when required to function autonomously); and (d) behavioral (use of diverse self-presentation strategies to strengthen ties to potential caregivers). Clinicians' understanding of the etiology and dynamics of dependency has improved substantially in recent years; current challenges include delineating useful subtypes of dependency, developing valid symptom criteria for Dependent Personality Disorder in DSM-5 and beyond, and working effectively with dependent patients in the age of managed care.

Personality type and patient education in hand therapy

Awareness of personality differences can improve the effectiveness of treatment and patient education in hand therapy. Therapists can create treatment plans and patient education efforts that match the communication and learning styles of each individual patient.

An Interactionist Perspective on Interpersonal Dependency

Interpersonal dependency—the tendency to look to others for nurturance, guidance, protection, and support, even in situations where autonomous functioning is possible—has become associated with passivity, immaturity, and dysfunction in the minds of mental health professionals. However, research suggests that dependent persons behave quite actively—even aggressively—in certain contexts. Although dependency is associated with certain forms of dysfunction (e.g., perpetration of domestic violence when close relationships are threatened), it is also linked with an array of adaptive behaviors (e.g., conscientiousness in complying with medical and psychotherapeutic treatment regimens). The cognitive/interactionist (C/I) model of interpersonal dependency provides a framework for understanding contextual variations in dependency-related responding: Although dependent behaviors vary from situation to situation based on perceived opportunities and risks, the dependent person’s core beliefs (a perception of oneself as helpless and weak) and motives (a desire to strengthen ties to potential caregivers) remain constant. Here I discuss theoretical and practical implications of the C/I model and summarize current trends in research on interpersonal dependency.

An exploratory study of the relationship between diverse life events and specific personality disorders in a sample of suicide attempters

Personality disorder (PD) increases risk for suicidal behavior. Certain life events (LE) can precipitate suicidal behaviors in patients with PD. A fundamental question is whether specific combinations of LE and PD increase suicidal risk. Four hundred forty-six suicide attempters (SA) were recruited from emergency rooms. We used a healthy control group (n = 515) to identify the best cut-off point for the instrument used to diagnose PD. We used the DSM-IV version of the International Personality Disorder Questionnaire-Screening Questionnaire, the Mini International Neuropsychiatric Interview, and the Social Adjustment Scale to assess PD, Axis I disorders, and LE, respectively. After controlling for Axis I disorders, we found that "Death of spouse" preceded suicidal acts in those with antisocial PD (FET p = 0.024) and patients with narcissistic PD attempted suicide after being Fired at work (FET p = 0.002), among others. Our data suggest the presence of particular LE-PD associations in suicide attempters. Some LE-PD relationships appear independent of Axis I disorders in suicide attempters. This may offer a basis for specific targeted therapies or prevention programs aimed at decreasing suicidal risk.

Personality traits and social behaviors predict the psychological adjustment of Chinese people with epilepsy

Very little is known about the psychosocial correlates of psychological morbidity among Chinese people with epilepsy (PWE). No studies have investigated the association between social relationships and psychological morbidity, while most studies examined only the negative impact of maladaptive personalities on psychological adjustment in PWE. This study examined the association of psychological morbidity with a broad array of personality traits and social skills in a sample of 54 Chinese PWE. Respondents completed the Temperament and Character Inventory (TCI), the Social Performance Survey Schedule (SPSS), and the Hospital Anxiety and Depression Scale (HADS) via semi-structured interview. Regression analyses revealed that, independent of demographic and medical variables and perceived impact, Harm Avoidance was positively associated with anxiety and depression whereas Self-Directedness was negatively associated with anxiety and depression; that Cooperativeness was inversely associated with anxiety. Social skills were inversely associated with depression whereas negative social skills were inversely associated with anxiety. Clinical implications of adaptive personality traits and social skills functioning are discussed.

Might the Rorschach be a projective test after all? Social projection of an undesired trait alters Rorschach Oral Dependency scores

The degree to which projection plays a role in Rorschach (Rorschach, 1921/1942) responding remains controversial, in part because extant data have yielded inconclusive results. In this investigation, I examined the impact of social projection on Rorschach Oral Dependency (ROD) scores using methods adapted from social cognition research. In Study 1, I prescreened 85 college students (40 women and 45 men) with the ROD scale and a widely used self-report measure of dependency, the Interpersonal Dependency Inventory (IDI; Hirschfeld et al., 1977). Results show that informing participants who scored low on the IDI that they were in fact highly dependent led to significant increases in ROD scores; I did not obtain parallel ROD increases for participants who scored high on the IDI or for participants who received low-dependent feedback. In Study 2, I examined a separate sample of 80 prescreened college students (40 women and 40 men) and showed that providing low self-report participants an opportunity to attribute dependency to a fictional target person prior to Rorschach responding attenuated the impact of high-dependent feedback on ROD scores. These results suggest that projection played a role in at least one domain of Rorschach responding. I discuss theoretical, clinical, and empirical implications of these results.

The Effect of Postoperative Symptom Experience, and Personality and Psychosocial Factors on Depression Among Postgastrectomy Patients in Japan

Depression, the most common affective disorder in cancer, has a major impact on quality of life. Various risk factors may interact and affect a cancer patient's depressive state. The purpose of this study was to examine the relationships between depression and postoperative symptom experience, personality, and psychosocial factors in Japanese gastrectomy patients. Causal relationships of these variables were also estimated. Eighty-two Japanese gastrectomy patients (M age = 63.63 years, SD = 10.21; men = 50, women = 32), who had been discharged within the last 3 years with no indication of cancer recurrence, participated in the study. Results showed significant correlations between depression and age, time-since-discharge, postoperative symptom experience, frequency of symptoms, self-esteem, and emotional support. Path analysis showed sufficient goodness of fit index (GFI = 0.993, AGFI = 0.963). Interpersonal dependency, emotional support, and marital status showed a direct effect on self-esteem, which, along with postoperative symptom experience, had a direct effect on depression. Findings provide a useful reference point for further understanding the mental health condition of postgastrectomy patients.

The complex relationship between dependency and domestic violence: Converging psychological factors and social forces

Research indicates that economic dependency in women and emotional dependency in men independently contribute to domestic-partner abuse risk and that high levels of emotional dependency in an abused partner may reduce the likelihood that the victimized person will terminate the relationship. An analysis of psychological factors and social forces that contribute to domestic violence suggests that multimodal intervention strategies are needed to combat this complex problem.

How interpersonal motives clarify the meaning of interpersonal behavior: a revised circumplex model

Circumplex models have organized interpersonal behavior along 2 orthogonal dimensions--communion (which emphasizes connection between people) and agency (which emphasizes one person's influence over the other). However, many empirical studies have disconfirmed certain predictions from these models. We therefore revised the model in 4 ways that highlight interpersonal motives. In our revision: (a) the negative pole of communion is indifference, not hostility; (b) a given behavior invites (not evokes) a desired reaction from the partner; (c) the complement of a behavior is a reaction that would satisfy the motive behind that behavior; (d) noncomplementary reactions induce negative affect. If the motive is unclear, the meaning of the behavior is ambiguous. This ambiguity helps explain failures in social support, miscommunications in everyday life, and features of most personality disorders. The model emphasizes measurable individual differences: Reactions that are complementary for one person need not be complementary for another.

Construct validity of the relationship profile test: three-year retest reliability and links with core personality traits, object relations, and interpersonal problems

The Relationship Profile Test (RPT; Bornstein & Languirand, 2003) is a 30-item self-report measure of destructive overdependence, dysfunctional detachment, and healthy dependency. Previous research has shown that the 3 RPT subscales have adequate internal consistency, good retest reliability over 23 and 85 weeks, and good convergent and discriminant validity with respect to measures of attachment style, relatedness, gender role, self-concept, alexithymia, locus of control, need for approval, and life satisfaction. In this investigation, we assessed the 3-year retest reliability of RPT scores in a northeastern liberal arts college student sample (Study 1) and evaluated the convergent and discriminant validity of RPT scores in a southern university sample (Study 2). Results generally supported the long-term stability and convergent and discriminant validity of RPT scores but also pointed to some limitations of the measure. We discuss implications of these results and describe future research directions.

Interpersonal dependency in older adults and the risks of developing mood and mobility problems when receiving care at home

Despite a broad interest in various types of dependency as they relate to older people (structured dependency, learned dependency, learned helplessness, and interdependency), research of dependency in older people has not included an individual difference measure of interpersonal dependency. Studies that have examined the correlates of interpersonal dependency in general populations have found links with mental health conditions such as depression and anxiety and also with physical illness. If these findings could generalise to older populations then there would be important intervention and financial implications for providers of health services to older adults. This research examined the correlates of interpersonal dependency in older adults using a new measure of interpersonal dependency-the Interpersonal Dependency Scale for Older Adults (IDS-OA). One hundred and five new clients aged 65-90 years recruited through a private home care agency responded to a postal survey requesting their completion of a questionnaire package. Interpersonal dependency was found to correlate significantly with both depression and mobility. In addition, a hierarchical regression analysis found that both higher interpersonal dependency and depression were significant positive predictors of poor mobility in older adults.

Client predictors of treatment retention and completion in a program for homeless veterans

This study assessed the value of a specific set of client variables in predicting treatment retention and completion of a rehabilitation program for homeless veterans. Participants were 596 (22 female) military veterans admitted to the Palo Alto, California Veterans Administration domicilary program between 1992 and 1995. Information was collected on a number of demographic and background characteristics previously used to predict treatment retention and outcomes. Results indicated that clients who were younger, female, and currently diagnosed with a depressive disorder, showed the highest rates of treatment retention and completion, whereas a current personality disorder diagnosis or history of psychiatric treatment was related to poorer rates of retention and completion. These results may be informative for identifying ways to modify this and other similar treatments to apply to a larger client population. The study's limitations were noted.

Maladaptive dependency traits in men

In this article, the authors intend to bring to the reader's attention the negative impact men's maladaptive dependency traits can have on their lives and methods by which these traits can be addressed in treatment. A review of the literature about dependence, dependency traits and dependent personality disorder is presented including the influence of early childhood experiences, gender differences, comorbidity with Axis I disorders, and assessment and treatment. Several clinical case examples highlighting the subtle expression of dependency traits in men are presented and discussed.

Contrasting Effects of Self-Schema Priming on Lexical Decisions and Interpersonal Stroop Task Performance: Evidence for a Cognitive/Interactionist Model of Interpersonal Dependency

Four experiments tested a key tenet of Bornstein's (1992, 1993) cognitive/interactionist (C/I) model of interpersonal dependency: that priming the helpless self-schema (HSS) alters processing of dependency-related information in dependent--but not nondependent--individuals. Experiments 1 and 2 assessed the effects of subliminal lexical priming and an emotional priming manipulation on lexical decision (LD) judgments for dependency-related words and control words. Experiments 3 and 4 assessed the effects of these same priming procedures on Interpersonal Stroop Task (IST) performance. As predicted, priming the HSS produced contrasting effects on different outcome measures, decreasing LD latencies, but increasing IST response times. Results are discussed in the context of the C/I model, and suggestions for future studies are offered.

Personality disorder traits during adolescence and relationships with family members during the transition to adulthood

Data from the Children in the Community Transitions Study, a prospective longitudinal investigation, were used to examine the association between adolescent personality disorder (PD) traits and conflict with family members during the transition to adulthood. PD traits at mean age 16 years were associated with elevated contact and conflict with family members between ages 17 and 27 years after Axis I disorders were controlled. There was a significant association between frequent contact and elevated conflict with family members. Both declined gradually during the transition to adulthood. Reduced family contact was associated with reduced family conflict, particularly among individuals who had numerous PD traits during adolescence. Among individuals who had a high level of family conflict during adolescence, reduced family contact between ages 17 and 22 years was associated with a subsequent reduction in conflict with family members between ages 22 and 27 years.

Construct Validity of the Relationship Profile Test: Impact of Gender, Gender Role, and Gender Role Stereotype

Research supports the construct validity of the Relationship Profile Test (RPT; Bornstein & Languirand, 2003), a 30-item, self-report measure of destructive overdependence (DO), dysfunctional detachment (DD), and healthy dependency. In this investigation, we assessed the relationships of gender, gender role, and gender role stereotype ratings to RPT subscale scores. In Study 1, we replicated earlier patterns of gender differences in RPT scores, assessed cross-sample consistency in gender difference effect sizes, and provided preliminary nonclinical norms for the RPT subscales. Study 2 showed that--as expected--DO items are perceived as stereotypically feminine, whereas DD items are perceived as stereotypically masculine. In Study 3, we examined the relationships of RPT subscale scores to masculinity, femininity, and androgyny scores. We discuss the theoretical, empirical, and clinical implications of these findings.

Construct validity of the relationship profile test: a self-report measure of dependency-detachment

This study evaluated the construct validity of the Relationship Profile Test (RPT; Bornstein & Languirand, 2003), a 30-item self-report measure of dependency-detachment that yields three subscale scores: (a) destructive overdependence, (b) dysfunctional detachment, and (c) healthy dependency. Scores on the RPT subscales generally showed the expected patterns of intercorrelations and gender differences, and comparison of RPT scores with scores on other tests supported the convergent and discriminant validity of each RPT subscale. Results of internal and retest reliability analyses were generally supportive as well, and suggested that the three RPT subscales assess aspects of the traits they purport to measure

Psychiatric patient- and informant-reported personality: predicting concurrent and future behavior

The authors investigated the criterion and incremental validity of personality reports from psychiatric patients and knowledgeable informants in predicting patient substance use, social and risky behaviors, and psychological distress. Patient and informant reports of patient personality and behavior were collected from an adult psychiatric sample (N = 94). Hierarchical regressions indicated that patient reports of personality accounted for significant variance in both concurrent (17%-42%) and future behavior assessed 1 year later (17%-40%). Informant reports contributed significantly to the prediction of several behaviors and most strongly to social behaviors. Behaviors were predicted equally well by self-reports and informant reports in prospective as in concurrent regressions. Thus, both patient and informant reports of personality contribute importantly to prediction of behavior, and predictive ability is stable across time.

Construct validity of the Relationship Profile Test: links with attachment, identity, relatedness, and affect

Studies suggest that overdependence and detachment have negative effects on psychological adjustment, health, and therapy process and outcome. In contrast, healthy dependency (ie., flexible, situation-appropriate help and support seeking) has beneficial effects in each of these areas. In this investigation, 90 college students (50 women and 40 men) completed a battery of personality scales including the Relationship Profile Test (RPT), a 30-item measure of destructive overdependence, dysfunctional detachment, and healthy dependency. RPT scores showed the expected patterns of subscale intercorrelations, gender differences, and links with measures of attachment style, identity, relatedness, and affect. Implications of these results for the construct validity of the RPT are discussed in the context of theoretical models of dependency-detachment.

Dependency, impulsivity, and self-harm: traits hypothesized to underlie the association between cluster B personality and substance use disorders

Cluster B personality disorders (PDs) (i.e., antisocial, borderline, histrionic, and narcissistic) typically show a high degree of comorbidity with substance use disorders (SUDs). Previous research suggests that the broad-based personality domains of Disinhibition and Negative Temperament/Neuroticism may be common factors to both types of disorders. Using a two-phase process (i.e., screening and follow-up), this study examined three lower-order personality traits (i.e., dependency, impulsivity, and self-harm) that fall within the Disinhibition and Neuroticism domains. The study evaluated the hypotheses that these traits (a) are related both to cluster B PDs and to SUDs; and (b) underlie the association between the two types of disorders. Results indicate that impulsivity and self-harm play a significant role in cluster B PDs and SUDs, as well as in their association with each other. However, dependency was not associated with either type of disorder. These results indicate that sets of individual traits can be of significant utility in understanding the comorbidity between PDs and SUDs.

Depression, adult attachment, and recollections of parental caring during childhood

The onset and course of depressive symptoms are influenced by a variety of interpersonal factors. Attachment theory provides a developmental framework for understanding the relationship between depressive symptoms and insecure attachment to one's parents and current romantic partner. The present study examined attachment theory for understanding depression and marital adjustment among 84 psychiatric inpatients diagnosed with major depressive disorder. Participants completed a diagnostic interview and self-report measures of depressive symptoms, adult attachment, marital adjustment, and recollections of childhood relationships with parents. Avoidant (but not anxious) adult attachment mediated the link between current depressive symptoms and patients' recollections of relationships with opposite-sex parents. Although nearly three fourths of the current sample of depressed psychiatric inpatients acknowledged the presence of marital problems, the negative correlation between depressive symptoms and marital adjustment did not reach statistical significance. Attachment theory may aid therapeutic approaches to depression within the context of marriage and other long-term romantic relationships.

The dependent patient in a psychiatric inpatient setting: relationship of interpersonal dependency to consultation and medication frequencies

To examine the relationship between interpersonal dependency and medical service use in a hospital setting, the number of medical consultations and psychotropic medication prescriptions were compared in matched, mixed-sex samples of 40 dependent and 40 nondependent psychiatric inpatients. Results indicated that dependent patients received more medical consultations and a greater number of medications than did nondependent patients with similar demographic and diagnostic profiles. Implications of these results for theoretical models of interpersonal dependency and for previous research on the dependency-help-seeking relationship are discussed. Practical implications of these findings for work with dependent patients are summarized.

[Psychosocial problem disclosure during primary care consultations]

OBJECTIVE

To examine how primary care patients with psychosocial problems actually introduce and present these topics. To examine the influence of some personality traits (emotional dependency and health locus of control) on psychosocial problem disclosure.

DESIGN

"Case control". Cases had a GHQ-12 score equal or higher than three. Controls were matched with cases according to GP, GPs' attribution of absence or presence of emotional distress sex, age and presence of chronic illness.

SETTING

Six single handed primary care practices.

MEASURES

Clinical and Socio-demographic data, Social Problems List, List of 12 Threatening Life Events, GHQ-12, Multidimensional Health Locus of Control, Interpersonal Dependency Inventory and a Social Support Index.

RESULTS

The introduction of psychosocial topics by patients is related to the attribution of emotional distress by GP. Patients identified correctly as not distressed present less often psychosocial topics compared to patients recognised as distressed. Distressed patients not recognised as such more often than the others did not offer any psychosocial cue. The personality measures did not influence the presentation of psychosocial problems.

CONCLUSIONS

The lack of psycho-social cues from patients and of patient-centred skills contributed to the non recognition of emotional distressed patients. GPs' active facilitation of the presentation of psychosocial topics in such patients would improve the recognition of emotional distress.

Dependency and suicidality in psychiatric inpatients

One hundred fifty-two psychiatric inpatients (91 women and 61 men) completed widely used objective (i.e., self-report) and projective measures of interpersonal dependency; scores on these measures were compared to two indices of suicidality derived from patients' chart records (i.e., number of past suicide attempts and physician judgments of suicidality at admission). High objective dependency scores were associated with high suicidality scores in women and men, even when level of depression was controlled for statistically. Projective dependency scores were unrelated to both suicidality indices.

Deconstructing dependency in a five-factor world: a meta-analytic review

Meta-analysis of studies assessing the relation between interpersonal dependency test scores and five-factor model (FFM) domain scores revealed that dependency scores are positively correlated with FFM Neuroticism and Agreeableness scores and negatively correlated with FFM Extraversion, Openness, and Conscientiousness scores. The magnitudes of these correlations were all in the small-to-moderate range, and comparable score intercorrelations were obtained when participants' dependency levels were assessed by means of a trait dependency questionnaire, dependent personality disorder questionnaire, or dependent personality disorder interview. These findings have implications for researchers' efforts to deconstruct dependency into its basic trait elements and for the dimensional approaches to personality disorders being considered for future versions of the Diagnostic and Statistical Manual of Mental Disorders.

Appropriateness of self-care responses to symptoms among elders: identifying pathways of influence

The purpose of the study was to investigate the separate and joint influences of sociodemographic, social situational (social support and interpersonal functioning), and symptom variables on the appropriateness of self-care responses to symptoms among elderly people. A cross-sectional face-to-face structured interview of a sample of noninstitutionalized, English-speaking persons 65 and older living in Minneapolis was used. The theoretical framework for the investigation was tested using graphical modeling techniques. A majority of the subjects responded appropriately to the symptoms they experienced. Gender was a key variable in understanding which of the sociodemographic, social support, interpersonal functioning, and symptom variables were related to the likelihood that individuals would engage in appropriate self-care. There appear to be fundamental differences in the influence of the social situational variables for men and women. If these results are confirmed in future studies, different intervention strategies may be needed for assisting elderly men and women in interpreting and responding to their symptoms.

Implicit and self-attributed dependency needs in dependent and histrionic personality disorders

Theorists speculate that dependent personality disorder (DPD) and histrionic personality disorder (HPD) are both associated with high levels of implicit (i.e., unconscious) dependency needs but speculate that only DPD is associated with high levels of self-attributed (i.e., conscious) dependency needs. To test this hypothesis, 444 undergraduates (236 women and 208 men) completed the Personality Diagnostic Questionnaire-Revised (PDQ-R), along with widely used measures of implicit dependency needs (the Rorschach Oral Dependency Scale; ROD), and self-attributed dependency needs (the Interpersonal Dependency Inventory; IDI). Correlational analyses and comparisons of IDI and ROD scores in participants scoring above and below the PDQ-R DPD and HPD thresholds supported theorists' speculations regarding implicit and self-attributed dependency needs in DPD and HPD. Implications of these results are discussed, and suggestions for future studies are offered.

Clarifying the social support theory-research linkage

Social support is a multi-faceted concept that has been difficult to conceptualize, define and measure. Although this concept has been extensively studied, there is little agreement among theoreticians and researchers as to its theoretical and operational definition. As a result, the concept remains fuzzy and almost anything that infers a social interaction may be considered social support. Social support researchers have consistently ignored the complexity of the concept and have measured the variable in a simplistic manner. The purpose of this article is to analyse the linkage between theory and research related to social support by categorizing definitions of social support, exploring the theoretical aspects and conceptualizations of the concept, proposing models of social support, and examining how social support is measured in current social support research (1993-1996). The inadequacy of current research and directions for future study are discussed.

Depathologizing dependency

For nearly a century psychologists, psychiatrists, and other mental health professionals have emphasized the maladaptive, problematic aspects of dependent personality traits. In this article, I review theoretical frameworks that have played a key role in pathologizing dependency, and then describe empirical findings which indicate that dependency is not simply a flaw or deficit in functioning but is also associated with a variety of healthy, adaptive traits, and behaviors. The theoretical, empirical, and clinical implications of depathologizing dependency are discussed.