Filling Gaps in the Nomological Networks for Dominance and Affiliation by Examining Self-Informant Agreement on Momentary Interpersonal Behavior

Interpersonal functioning involves an interplay of subjective perceptions and overt behavior. This study examines agreement between self and informant reports of behavior measured naturalistically to investigate the associations between observable behavior, self-perceptions, and others’ perceptions and to enrich the nomological networks for the domains of dominance and affiliation. We studied a sample of romantic couples (N=193) who rated their own and their partner’s interpersonal behavior during a 21-day ambulatory assessment (AA) protocol. We used a multitrait-multimethod-multirater correlation matrix including self- and informant-reported averages and variability of dominance and affiliation measured by AA and cross-sectional self-reports of dominance, affiliation, and interpersonal distress. There was no self-informant agreement on dominance measured by AA, but there was moderate agreement on affiliation averages and variability. Only AA self-reports of average dominance and affiliation, not informant reports, converged with analogous cross-sectional self-reports. Both self and informant reports of dominance and affiliation variability correlated with self-reported interpersonal distress. Results suggest that the internal versus external experiences of dominance and affiliation differ and that these differences have important implications in everyday interpersonal functioning. Our findings also show that self-perceptions of variability in dominance and affiliation, others’ perceptions of variability, and actual behavioral variability relate to interpersonal problems.

Narcissistic Personality Disorder: Are Psychodynamic Theories and the Alternative DSM-5 Model for Personality Disorders Finally Going to Meet?

Narcissistic Personality Disorder is the new borderline personality disorder of our current era. There have been recent developments on narcissism that are certainly worthwhile examining. Firstly, relational and intersubjective psychoanalysts have been rethinking the underlying concepts of narcissism, focusing on the development of self and relations to others. Secondly, in the DSM-5, the Alternative DSM-5 Model for Personality Disorders (AMPD) was presented for a dimensional evaluation of the severity of personality disorder pathology. The combined dimensional and trait conceptualization of NPD opened the door to new integrated diagnostic perspectives, including both internal and interpersonal functioning. Finally, Pincus and Lukowitsky encourage clinicians to use a hierarchical model of pathological narcissism, as it opens up opportunities for shared points of interest in empirical research from different scholarly perspectives. As for most non-psychodynamic clinicians and researchers the DSM-5 clearly bears dominant weight in their work, we will take the AMPD model for NPD as our point of reference. We will discuss the narcissist's unique pattern of self-impairments in identity and self-direction, and of interpersonal disfunctioning (evaluated by assessing empathy and intimacy). Subsequently, we will examine how contemporary psychodynamic theories and the hierarchical model of Pincus and Lukowitsky additionally inform or contradict the AMPD. For us, one of the big advantages of the AMPD is the use of structured clinical evaluations of disturbances of the self and interpersonal functioning and the dimensional evaluation of severity. As psychodynamically oriented therapists, we are enthusiastic about the opportunities for inclusion of psychodynamic concepts, but we also discuss a number of sticking points.

The Ageing Brain in Context

Successful interpersonal functioning relies upon the dynamic interplay of several complex cognitive and socio-emotional processes, enabling us to anticipate, predict, and respond appropriately to the behaviour of others. While significant attention has been paid to the emergence of these functions in childhood, comparatively less research has addressed how social cognition continues to evolve and change across the lifespan. This chapter provides a comprehensive overview of how changes in social cognition arise as a natural consequence of healthy ageing, with important implications for how we construct and assess these processes in older adults. It then considers how degeneration of large-scale brain networks specialized for socio-emotional processing disrupts interpersonal functioning in dementia syndromes, and the mechanisms driving such impairments. In doing so, we aim to provide an empirically grounded road map to understand the dynamic nature of social cognitive function across the lifespan with a view to promoting resilience and well-being in later years.

TFP Extended: Development and Recent Advances

Recent advances in the understanding of personality pathology have contributed to an emphasis on the core of personality pathology as deficits in self-functioning and interpersonal functioning at different levels of severity that must be assessed for clinical intervention. In concert with these conceptual and empirical advances, transference-focused psychotherapy (TFP), an empirically supported psychodynamic treatment for borderline personality disorder, has been in constant development with extensive clinical use. This article describes an object relations model for conceptualizing and assessing levels of personality organization, a transdiagnostic approach to personality pathology, and related treatment modifications, thus expanding the utilization of TFP beyond borderline personality disorder to the full range of personality dysfunction. The core of this treatment approach is a sequential interpretive process between patient and therapist. This process takes place within the context of a structured treatment frame tailored to the unique individual with problems in self-functioning and interpersonal functioning in his/her particular environment.

Editorial Introduction to the Special Issue: Recent Advances in Transference-Focused Psychotherapy: Extending and Refining the Treatment Model

The authors introduce this Special Issue of Psychodynamic Psychiatry focused on developments in the practice of Transference-Focused Psychotherapy (TFP). In the context of an evolving diagnostic system that increasingly focuses on the underlying dimensions related to self and interpersonal functioning that characterize personality disorders, the authors provide an overview of the development and nature of TFP, and preview a series of contributions that describe the refinement of TFP and is broadening application across the spectrum of personality disorder, age ranges, and clinical settings.

Personality Functioning and Mentalizing in Patients With Subthreshold or Diagnosed Borderline Personality Disorder: Implications for ICD-11

The 11th revision of the International Classification of Diseases for Mortality and Morbidity Statistics (ICD-11) defines personality disorder according to personality functioning, which relates to self- and interpersonal functioning. The aim of the present study was to assess the relationship between mentalizing and personality functioning in patients with subthreshold or diagnosed borderline personality disorder. A total of 116 eligible participants were included. Mentalizing was assessed using the Mentalization Questionnaire (MZQ), personality functioning (self- and interpersonal functioning) was assessed using the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF), and borderline severity was assessed using the Zanarini Rating Scale (ZAN-BPD). Mediation analysis was employed to test if mentalizing accounted for the relationship between borderline severity and self- and interpersonal functioning. We found a significant relationship between borderline severity and both subscales of the LPFS-BF. Mentalizing fully and significantly mediated the relationship between borderline severity and interpersonal functioning. However, mentalizing only partly mediated the relationship between borderline severity and self-functioning. Controlling for the covariates gender and age did not impact the results. Mentalizing is likely to be involved in the ICD-11 model of personality functioning, especially interpersonal functioning. This could emphasize the relevance of therapy aimed at strengthening mentalizing abilities when treating personality pathology in general and people with borderline personality disorder in particular. However, self-functioning may be more nuanced, as aspects other than mentalizing also influence self-functioning. The study is explorative in nature and has methodological limitations that require caution in the interpretation and generalizability.

A Proposed Classification of ICD-11 Severity Degrees of Personality Pathology Using the Self and Interpersonal Functioning Scale

Background: The 11th version of the World Health Organization's International Classification of Diseases (ICD-11) has adopted a dimensional approach to personality disorder (PD) nosology. Notably, it includes an assessment of PD degree of severity, which can be classified according to five categories. To date, there is no gold standard measure for assessing degree of PD severity based on the ICD-11 model, and there are no empirically-based anchor points to delineate the proposed categories. With the operationalization of PD degrees of severity in the ICD-11 PD model now being closely aligned with Criterion A of the DSM-5 Alternative Model for Personality Disorders (AMPD), sharing a focus on self and interpersonal dysfunction, self-report instruments developed for the latter model might prove useful as screening tools to determine degrees of severity in the former.Methods: The Self and Interpersonal Functioning Scale, a brief validated self-report questionnaire originally designed to assess level of personality pathology according to the AMPD framework, was used to derive anchor points to delineate the five severity degrees from the ICD-11 PD model. Data from five clinical and non-clinical samples (total N = 2,240) allowed identifying anchor points for classification, based on Receiver Operating Characteristic curve analysis, Latent Class Analysis, and data distribution statistics. Categories were validated using multiple indices pertaining to externalizing and internalizing symptoms relevant to PD.Results: Analyses yielded the following anchor points for PD degrees of severity: No PD = 0–1.04; Personality Difficulty = 1.05–1.29; Mild PD = 1.30–1.89; Moderate PD = 1.90–2.49; and Severe PD = 2.50 and above. A clear gradient of severity across the five categories was observed in all samples. A high number of significant contrasts among PD categories were also observed on external variables, consistent with the ICD-11 PD degree of severity operationalization.Conclusions: The present study provides potentially useful guidelines to determine severity of personality pathology based on the ICD-11 model. The use of a brief self-report questionnaire as a screening tool for assessing PD degrees of severity should be seen as a time-efficient support for clinical decision and treatment planning.

Narrative Coherence of Turning Point Memories: Associations With Psychological Well-Being, Identity Functioning, and Personality Disorder Symptoms

Individuals develop a narrative identity through constructing and internalizing an evolving life story composed of significant autobiographical memories. The ability to narrate these memories in a coherent manner has been related to well-being, identity functioning, and personality pathology. Previous studies have particularly focused on coherence of life story narratives, overlooking coherence of single event memories that make up the life story. The present study addressed this gap by examining associations between narrative coherence of single turning point memories and psychological well-being, identity functioning, and personality disorder (PD) symptoms among 333 Belgian emerging adults (72.1% female; Mage = 22.56, SD = 3.13, age range = 18–30). In addition, the present study tested whether narrative coherence could predict unique variance in PD symptoms above and beyond identity and interpersonal functioning, both considered key components of personality pathology. The findings showed that narrative coherence was not significantly related to psychological well-being, but yielded significant negative associations with disturbed identity functioning and antisocial PD symptoms. Furthermore, narrative coherence predicted unique variance in antisocial PD symptoms above and beyond identity functioning, but did not predict unique variance in borderline and antisocial PD symptoms above and beyond both identity and interpersonal functioning. Collectively, these findings suggest that narrative incoherence within single event memories might be characteristic for disturbed identity functioning and antisocial personality pathology.