'Commanded to be ill, accused of being well' a lived-experience-led, qualitative investigation of service user perspectives on the impact of emotionally unstable personality disorder diagnosis on self-concept

BACKGROUND

Emotionally unstable personality disorder (EUPD) is a mental disorder impairing health and functioning and increasing suicide risk and it is a stigmatised condition among healthcare professionals. EUPD diagnosis may significantly affect self-concept, yet no previous investigation has explicitly examined this.

AIMS

To explore service user perspectives on (a) the impact of EUPD diagnosis on self-concept and (b) mediators of positive and negative impacts.

METHODS

Service user-led, qualitative semi-structured interviews with n = 10 participants with EUPD.

RESULTS

Perceived impacts of diagnosis on self-concept were, broadly, negative. Factors mediating between positive and negative impacts included: exposure to online stigma and public understanding, the responses of relatives, friends, intimate partners and trusted communities, and the attitudes and behaviours of healthcare staff. There were indications that recent guideline and practice developments (guidelines recommending alternatives to inpatient admissions for people with EUPD and "recovery-focused" approaches to self-harm) may have worsened inpatient staff attitudes and led to more rejecting service user experiences.

CONCLUSION

Mitigating negative impacts of EUPD diagnosis on self-concept may require addressing hateful, online content related to EUPD; revisiting use of the personality disorder label; improving medical communication around diagnosis and improving practice and policy in the management of EUPD in inpatient settings.

Maltreatment in Childhood and Perceived Partner Responsiveness in Adult Romantic Relationships: A Dyadic Daily Diary and Longitudinal Study

This study examined the associations between childhood maltreatment (CM) and the mean-level of perceived partner responsiveness (PPR; the extent to which individuals feel cared for, understood, and validated by their partner) over 35 days, the day-to-day variability in PPR, and the initial levels and trajectories of PPR over 1 year in community couples. Both members of 228 couples completed a self-reported measure of CM and provided daily reports of PPR over 35 days and retrospective reports of PPR at three time points over 1 year. A person's greater CM was related to a lower mean level of PPR over 35 days and to a lower initial level of their own PPR. A person's sexual abuse, physical neglect, and emotional neglect had an effect over and above other forms of CM in these associations. A person's greater CM was also related to higher day-to-day variability in their own and their partner's PPR, and a person's greater emotional neglect was associated with a sharper decrease over time in their own PPR. These findings provide a more fine-grained understanding of how CM may affect the perceptions of being cared about, accepted, and validated by a partner on a daily basis and over time.

Value Consistency across Relational Roles and Basic Psychological Needs Satisfaction: The Mediating Role of Self-Concept Clarity

Living in today’s complex social world can contribute to the development of a multi-faceted personal identity and to the risk of identity dispersion. This study focused on values, which are conceptualised as the core of one’s personal identity. It aimed to explore the within-person value consistency across relational roles (i.e., relationships with parents, partners, and friends) and to analyse the association between value consistency, self-concept clarity, and basic psychological needs satisfaction. One hundred ninety-five Italian young adults (F = 85%; Mage = 26.65, SD = 3.83) participated in the study. They completed the Values in Context Questionnaire, the Self-Concept Clarity Scale, and the satisfaction subscale from the Basic Needs Satisfaction and Frustration Scale. Findings showed high value consistencies across the relational roles. Specifically, consistency is higher when values as a partner and values as a friend are considered. Moreover, the relation between value consistency and basic psychological needs satisfaction was fully mediated by self-concept clarity. Limitations of the study, future research developments, and practical implications of the results are discussed.

Compartmentalization of self-representations in female survivors of sexual abuse and assault, with posttraumatic stress disorder (PTSD)

BACKGROUND

This study examined the structure of the self-concept in a sample of sexual trauma survivors with posttraumatic stress disorder (PTSD) compared to healthy controls using a self-descriptive card-sorting task. We explored whether individuals with PTSD possess a highly affectively-compartmentalized self-structure, whereby positive and negative self-attributes are sectioned off into separate components of self-concept (e.g. self as an employee, lover, mother). We also examined redundancy (i.e. overlap) of positive and negative self-attributes across the different components of self-concept.

METHOD

Participants generated a set of self-aspects that reflected their own life (e.g. 'self at work'). They were then asked to describe their self-aspects using list of positive or negative attributes.

RESULTS

Results revealed that, relative to the control group, the PTSD group used a greater proportion of negative attributes and had a more compartmentalized self-structure. However, there were no significant differences between the PTSD and control groups in positive or negative redundancy. Sensitivity analyses demonstrated that the key findings were not accounted for by comorbid diagnosis of depression.

CONCLUSION

Findings indicated that the self-structure is organized differently in those with PTSD, relative to those with depression or good mental health.

Strange-face illusions during eye-to-eye gazing in dyads: specific effects on derealization, depersonalization and dissociative identity

Experimentally induced strange-face illusions can be perceived when two individuals look at each other in the eyes under low illumination for about 10 minutes. This task of subject-other eye-to-eye gazing produces the following perceptions by the subject: (i) mild to huge deformations and color/shape changes of face and facial features; (ii) lifeless, unmoving faces and immaterial presences akin to out-of-body experiences; (iii) pseudo-hallucinations, enlightened 'idealized' faces and personalities - rather than the other's actual face. Dissociative phenomena seem to be involved, whereas the effects of non-pathological dissociation on strange-face illusions have not yet been directly investigated. In the present study, dissociative perceptions and strange-face illusions were measured through self-report questionnaires on a large sample (N = 90) of healthy young individuals. Results of correlation and factor analyses suggest that strange-face illusions can involve, respectively: (i) strange-face illusions correlated to derealization; (ii) strange-face illusions correlated to depersonalization; and (iii) strange-face illusions of identity, which are supposedly correlated to identity dissociation. The findings support the separation between detachment and compartmentalization in dissociative processes. Effects of gender show that strange-face illusions are more frequent in men with respect to women if dyads are composed of individuals of different-gender. Furthermore, drawings of strange-faces, which were perceived by portrait artists in place the others' faces, allowed a direct illustration of examples of dissociative identities. Findings are discussed in relation to the three-level model of self-referential processing.

Self-concept structure and borderline personality disorder: evidence for negative compartmentalization

BACKGROUND AND OBJECTIVES

Borderline personality disorder (BPD) is characterized by an unstable and incongruent self-concept. However, there is a dearth of empirical studies investigating self-concept in BPD. In order to bridge this research gap, the purpose of this study was to apply an in-depth analysis of structural aspects of the self-concept in BPD.

METHODS

We examined the degree of compartmentalization, i.e., a tendency to organize knowledge about the self into discrete, extremely valenced (i.e., either positive or negative) categories (Showers, 1992).

RESULTS

We hypothesized and found that BPD patients had the most compartmentalized self-concept structure and a higher proportion of negative self-attributes relative to both a non-clinical and a depressed control group. Moreover, BPD patients rated negative self-aspects as more important than positive ones relative to non-clinical controls.

LIMITATIONS

We cannot determine whether causal relationships exist between psychological symptoms and self-concept structure. Moreover, further comparisons to patients with other psychiatric disorders are necessary in order to further confirm the clinical specificity of our results.

CONCLUSIONS

Our findings indicate that a negative compartmentalized self-concept is a specific feature of BPD. Implications for future research, psychological assessment, and psychotherapeutic treatment are discussed.

Self-Concept Structure and the Quality of Self-Knowledge

This article explores the hidden vulnerability of individuals with compartmentalized self-concept structures by linking research on self-organization to related models of self-functioning. Across three studies, college students completed self-descriptive card sorts as a measure of self-concept structure and either the Contingencies of Self-Worth Scale, Likert ratings of perceived authenticity of self-aspects, or a response latency measure of self-esteem accessibility. In all, there were 382 participants (247 females; 77% White, 6% Hispanic, 5% Black, 5% Asian, 4% Native American, and 3% other). Consistent with their unstable self-evaluations, compartmentalized individuals report greater contingencies of self-worth and describe their experience of multiple self-aspects as less authentic than do individuals with integrative self-organization. Compartmentalized individuals also make global self-evaluations more slowly than do integrative individuals. Together with previous findings on self-clarity, these results suggest that compartmentalized individuals may experience difficulties in how they know the self, whereas individuals with integrative self-organization may display greater continuity and evaluative consistency across self-aspects, with easier access to evaluative self-knowledge.

Between desire and rape - narratives about being intimate partners and becoming pregnant in a violent relationship

BACKGROUND

Women subjected to intimate partner violence (IPV) experience different forms of abuse. Sexual violence is often under-reported because physically abused women, in particular, might see forced sex as an obligatory part of the sexual interplay. Accordingly, abused women have less sexual autonomy and experience unplanned pregnancies more often than other women.

OBJECTIVE

To describe and analyse nine Swedish women's retrospective stories about IPV with a focus on power and coping strategies as intimate partners, particularly regarding experiences of sex, contraception, and becoming pregnant. Design : Nine qualitative interviews were carried out with women who had been subjected to very severe violence in their intimate relationships and during at least one pregnancy. The stories were analysed using 'Narrative method' with the emphasis on the women's lived experiences.

RESULTS

Despite the violence and many contradictory and ambivalent feelings, two of the women described having sex as desirable, reciprocal and as a respite from the rest of the relationship. The other seven women gave a negative and totally different picture, and they viewed sex either as obligatory or as a necessity to prevent or soothe aggression or referred to it as rape and as something that was physically forced upon them. The women's descriptions of their pregnancies ranged from being carefully planned and mostly wanted to completely unwelcome and including flawed contraceptive efforts with subsequent abortions.

CONCLUSIONS

Women subjected to IPV have diverse and complex experiences that have effects on all parts of the relationship. Intimacy might for some turn into force and rape, but for others sex does not necessarily exclude pleasure and desire and can be a haven of rest from an otherwise violent relationship. Accordingly, women may tell stories that differ from the ones expected as 'the typical abuse story', and this complexity needs to be recognized and dealt with when women seek healthcare, especially concerning contraceptives, abortions, and pregnancies.

Self-structure and emotional experience

Two studies examine individual differences in affective reactivity by linking emotional experience to cognitive self-structure. Consistent with the view that individuals with an evaluative compartmentalised self-structure are emotionally reactive, we find that evaluative compartmentalisation is associated with the experience of, and desire for, high-arousal positive (HAP) affect, whereas evaluative integration is associated with the experience of low-arousal positive (LAP) and low-arousal negative affect and the desire for LAP affect. Although compartmentalised individuals are less granular in their tendency to report experiencing both HAP and LAP, they are strongly differentiated in their perceptions of high-arousal states as positive and low-arousal states as negative. Thus, compartmentalised individuals' reactivity may be explained by their preference for HAP states and the 'breadth' of their emotionality (e.g., the tendency to experience sadness and nervousness at the same time).

Self-concept organisation and mental toughness in sport

The present study examines the relationship between individual differences in evaluative self-organisation and mental toughness in sport, proposing that motivation and emotional resiliency (facets of mental toughness) stem from differences in core self. A cross-sectional assessment of 105 athletes competing at a range of performance levels took part in an online study including measures of self-reported mental toughness (Sport Mental Toughness Questionnaire; Sheard, M., Golby, J., & van Wersch, A. (2009). Progress towards construct validation of the Sports Mental Toughness Questionnaire (SMTQ). European Journal of Psychological Assessment, 25(3), 186-193. doi:10.1027/1015-5759.25.3.186) and self-organisation (self-descriptive attribute task; Showers, C. J. (2002). Integration and compartmentalisation: A model of self-structure and self-change. In D. Cervone & W. Mischel (Eds.), Advances in personality science (pp. 271-291). New York, NY: Guilford Press). As predicted, global mental toughness was associated with self-concept positivity, which was particularly high in individuals with positive-integrative self-organisation (individuals who distribute positive and negative self-attributes evenly across multiple selves). Specifically, positive integration was associated with constancy (commitment to goal achievement despite obstacles and the potential for failure), which extends presumably from positive integratives' emotional stability and drive to resolve negative self-beliefs.

Accounting for the association between childhood maltreatment and alcohol-use disorders in males: a twin study

BACKGROUND

An association between childhood maltreatment and subsequent alcohol abuse and/or dependence (AAD) has been found in multiple studies of females. Less is known about the association between childhood maltreatment and AAD among males, and the mechanisms that underlie this association in either gender. One explanation is that childhood maltreatment increases risk for AAD. An alternative explanation is that the same genetic or environmental factors that increase a child's risk for being maltreated also contribute to risk for AAD in adulthood.

METHOD

Lifetime diagnosis of AAD was assessed using structured clinical interviews in a sample of 3527 male participants aged 19-56 years from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. The sources of childhood maltreatment-AAD association were estimated using both a matched case-control analysis of twin pairs discordant for childhood maltreatment and bivariate twin modeling.

RESULTS

Approximately 9% of participants reported childhood maltreatment, defined as serious neglect, molestation, or physical abuse occurring before the age of 15 years. Those who experienced childhood maltreatment were 1.74 times as likely to meet AAD criteria compared with males who did not experience childhood maltreatment. The childhood maltreatment-AAD association largely reflected environmental factors in common to members of twin pairs. Additional exploratory analyses provided evidence that AAD risk associated with childhood maltreatment was significantly attenuated after adjusting for measured family-level risk factors.

CONCLUSIONS

Males who experienced childhood maltreatment had an increased risk for AAD. Our results suggest that the childhood maltreatment-AAD association is attributable to broader environmental adversity shared between twins.

Self-concept and self-esteem: How the content of the self-concept reveals sources and functions of self-esteem

The relations of content of self-concept to self-esteem may reflect the role of different factors in developing self-esteem. On the basis of theories describing sources of self-esteem, we distinguished four domains of self-beliefs: agency, morality, strength and energy to act, and acceptance by others, which we hypothesized to be related to self-esteem. In two studies, involving 411 university students, the relationship between self-esteem and self-concept was examined. The results confirmed relative independence of these four domains. Self-evaluation of agency was the strongest predictor of self-esteem, followed by self-evaluation of strength and energy to act, and self-evaluation of acceptance by others. Self-evaluation regarding morality turned out to have either no or negative relationship with self-esteem. The results supported the theories assuming that either perception of one's own agency or acceptance by others are sources of self-esteem.

The Multiple Self-Aspects Framework: Self-Concept Representation and Its Implications

The multiple self-aspects framework (MSF) conceives of the self-concept as a collection of multiple, context-dependent selves. From this perspective, five principles are derived, addressing issues such as how context activates particular regions of self-knowledge and how self-relevant feedback affects self-evaluations and affect. Support for these principles is discussed. Furthermore, the MSF advances several novel predictions, including how active self-aspects filter one’s experiences and perceptions, how the impact of chronic accessibility is more circumscribed than previously realized, and how self-concept representation modulates the experience of affect. In addition, the MSF helps integrate isolated lines of research within several diverse literatures, including self-regulation, stability and variability for the self, the integration of others into the self-concept, and several individual difference factors as well. Overall, the current work speaks to issues of relevance to several subdisciplines in psychology (e.g., cultural, developmental, personality, social) interested in the self, providing conceptual and methodological insights.

Compartmentalization and integration: the evaluative organization of contextualized selves

This article reviews research on the evaluative organization (compartmentalized or integrative) of contextualized selves. Evaluatively compartmentalized self-structures consist of multiple selves, each of which is either mostly positive or mostly negative. Evaluatively integrative self-structures represent each self with a mixture of positive and negative attributes. These different styles of organizing self-knowledge have been linked to current mood and self-esteem. More recently, studies of evaluative organization have examined self-esteem stability, coping styles (e.g., self-enhancement or resilience), change in self-organization, as well as psychopathology and psychological treatment. Findings suggest that compartmentalized self-structures, typically associated with the highest levels of self-esteem, may be vulnerable to instability. In contrast, the more moderate self-views of individuals with integrative self-structures may offer greater stability, increased resilience, and a means of coping with extreme stress.

TEMPEST in a gallimaufry: applying multilevel systems theory to person-in-context research

Terminological ambiguity and inattention to personal and contextual multilevel systems undermine personality, self, and identity theories. Hierarchical and heterarchical systems theories are used to describe contents and processes existing within and across three interrelated multilevel systems: levels of organization, representation, and integration. Materially nested levels of organization are used to distinguish persons from contexts and personal from social identity. Functionally nested levels of representation are used to distinguish personal identity from the sense of identity and symbolic (belief) from iconic (schema) systems. Levels of integration are hypothesized to unfold separately but interdependently across levels of representation. Multilevel system configurations clarify alternative conceptualizations of traits and contextualized identity. Methodological implications for measurement and analysis (e.g., integrating variable- and pattern-centered methods) are briefly described.

Self-structure and self-esteem stability: the hidden vulnerability of compartmentalization

The present studies examined the association between self-concept structure and stability of self-esteem. In two daily diary studies, evaluative integration (organizing positively and negatively valenced self-beliefs into the same self-aspects) was associated with more stable self-esteem than evaluative compartmentalization (organizing positively and negatively valenced self-beliefs into separate self-aspects) among individuals with generally high self-esteem. Moreover, analyses of self-esteem reactivity confirmed that the sensitivity of state self-esteem to daily events was greater for compartmentalized individuals than for individuals with relatively integrative self-concept structures. Compartmentalization also was associated with greater sensitivity to experiences of social rejection in the laboratory, consistent with the view that integration affords greater stability of self-evaluations. These results suggest that some of the benefits believed to be associated with compartmentalization (such as high self-esteem) may have hidden costs that have not previously been considered.