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Conceptualization and preliminary validation of a depressive personality concept

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Abstract

This paper proposes a depressive personality organization—a unique set of traits. It proposes a psychodynamic and psychiatric operationalization and reports on a preliminary validation through the construction of a questionnaire and the investigation of its psychometric properties in three nonclinical samples and a clinical sample of depressed patients. Preliminary results support the validity of the instrument and the underlying theoretical conceptualization of a depressive personality. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
CONCEPTUALIZATION AND
PRELIMINARY VALIDATION OF A
DEPRESSIVE PERSONALITY CONCEPT
Rui C. Campos, PhD
University of Évora
This paper proposes a depressive personality organization—a unique set of
traits. It proposes a psychodynamic and psychiatric operationalization and
reports on a preliminary validation through the construction of a questionnaire
and the investigation of its psychometric properties in three nonclinical samples
and a clinical sample of depressed patients. Preliminary results support the
validity of the instrument and the underlying theoretical conceptualization of a
depressive personality.
Keywords: depressive personality, inventory, conceptual proposition, validation
The concept of depressive personality, akin to that of depression, has been discussed for
many years in the psychiatric and psychoanalytic literature. It has been described and used
by clinicians and researchers from several theoretical perspectives (Campos, 2009a;
Phillips, Gunderson, Hirschfeld, & Smith, 1990;Phillips, Hirschfeld, Shea, & Gunderson,
1993;Ryder, Bagby, & Schuler, 2002), particularly by psychodynamic clinicians and
classic authors in German psychiatry (Klein & Miller, 1997;Koldobsky, 2003). For Klein,
Wonderlich, and Shea (1993), the concept of a depressive personality is at the crossroads
between depression and personality because the two concepts merge into one. The
depressed mood and the other depressive features are presented as chronic and stable
personality traits; there is a depressive personality or character structure (see also Klein,
Durbin, Shankman, & Santiago, 2002).
Rui C. Campos, PhD, Department of Psychology and Research Center for Education and Psychol-
ogy, University of Évora, Portugal.
I acknowledge the research assistants of the University of Évora, Portugal for their valuable
help with data collection. Grateful thanks are also extended to all of the participants in this study.
I thank Prof. Sidney Blatt for his important contributions to a previous version of this paper. I also
wish to thank Prof. Bruno Gonçalves and Prof. Teresa Fagulha for their important assistance in the
items development process.
Correspondence concerning this article should be addressed to Rui C. Campos, PhD, Depart-
ment of Psychology, University of Évora, Apartado 94, Évora, Portugal 7002-554. E-mail:
rcampos@uevora.pt
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Psychoanalytic Psychology © 2013 American Psychological Association
2013, Vol. 30, No. 4, 601–620 0736-9735/13/$12.00 DOI: 10.1037/a0033961
601
The aim of this paper is to present a conceptual definition of the depressive personality
and to validate it by developing a questionnaire, the Depressive Traits Inventory, and
examining its psychometric properties.
A Comprehensive Concept of Depressive Personality
Initially the discussion of a depressive personality was largely limited to the German
phenomenologists such as Kraepelin, Kretschmer, and Schneider. Kraepelin (1921) used
the term depressive temperament to refer to a basic predisposition to depression. Kraepelin
(1921) characterized a relatively stable depressive temperament as predominantly self-
critical, desperate, serious, prone to feelings of guilt and low self-confidence, a combi-
nation which can progress to an affective illness. Kretschmer (1925) expressed a similar
view, adding that depressive traits can be observed in normal individuals as well as
patients. Kretschmer postulated, like Kraepelin, a continuity between depressive temper-
ament and manic-depressive illness, with the temperament presenting the fundamental
psychological characteristics of the affective illness. Schneider (1959) incorporated char-
acteristics from previous descriptions of the depressive temperament into his concept of
depressive psychopathy but included other features such as anhedonia, moderate skepti-
cism, strong feelings of doubt, constant worry and restlessness, pessimism, difficulties
relaxing, and a gloomy outlook.
Much of the literature describing the depressive personality can be found in the
psychoanalytic literature, especially since the 1960s and 1970s (Huprich, 1998;Klein &
Vocisano, 1999). Unlike the classic German psychiatrists, psychoanalytic authors did not
define categories or types of depressive personality, but rather defined premorbid person-
ality traits that increased the risk for depression (Bagby, Ryder, & Schuller, 2003;Ryder
et al., 2002). Blatt (1966), in a review of Shapiro’s now classic Neurotic Styles, noted the
lack of a depressive style among the various neurotic styles so vividly described. Despite
the differences between the classic German psychiatry and psychoanalysis regarding the
etiology of depressive temperament and personality, their clinical descriptions are very
similar (Klein & Vocisano, 1999). Many psychoanalytic theorists have focused on
dependency/orality and obsession/anality (Bagby et al., 2003;Blatt, 2008;Ryder et al.,
2002). Blatt (1974,1990,2004;Blatt & Zuroff, 1992) identified two distinct depressive
personalities—a dependent or anaclitic and a self-critical or introjective personality
organization. The central feelings in the anaclitic depression are helplessness, weakness,
feelings of depletion, fears of abandonment and of being unloved. There are marked
desires to be cared for, protected, and supported and a desperate search for satisfaction, an
intense need to be loved, a desperate struggle to maintain direct contact with others (Blatt,
1974, p. 107), and feeling unable to find gratification and comfort. Anaclitic individuals
have great vulnerability to experiences of interpersonal loss and feelings of loneliness,
sadness, rejection, and abandonment (Blatt & Shichman, 1983). Others are valued pri-
marily for their ability to meet the needs of these individuals.
The introjective depressive personality organization has feelings of unworthiness, of
not being worthy of love, guilt, and not having lived up to expectations (Blatt, 1974,
2004). Introjective individuals are vulnerable to disapproval and criticism and are very
demanding of themselves and of others and have an intense morality, a constant self-
evaluation, and feelings of guilt about failure and transgression (Blatt, 2008;Blatt &
Shichman, 1983). This depressive personality organization is characterized by an excess
of perfectionism, a tendency to take on responsibility and feelings of failing to gain
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602 CAMPOS
acceptance and recognition, with constant concerns about being criticized and punished.
The excessive involvement in several activities can be seen as a compensation mechanism
for feelings of inferiority, guilt, self-criticism, and devaluation.
These distinctions between a depression focused on issues of dependency and issues
of self-worth and autonomy are also presented in other theoretical formulations including
those of Bowlby (1980);Arieti and Bemporad (1980), and Beck (1983).Bowlby (1980),
from an ethological and object relation point of view, distinguishes individuals with an
insecure attachment from those compulsively centered on the Self. The former are highly
dependent and seek contact with others. The latter avoid relationships and focus primarily
on themselves. Excessive autonomy can be seen, according to Bowlby, as a defense
against the frustration felt in early relationships. These two types of personality organi-
zation can predispose individuals to depression (Blatt & Zuroff, 1992).
Kernberg (1970,1988) incorporated both anaclitic and introjective elements in one
single concept of a depressive-masochistic personality, linking it to the concept of moral
masochism characterized by a severe superego; strong dependency on support, love, and
acceptance from others; and difficulties in expressing aggression. Coimbra de Matos
(2001,2002) argues for a single depressive personality, which includes traits like depres-
sive humor, irritability, low self-esteem, guilt, a severe superego, vulnerability to loss,
idealization of the past, not feeling loved and giving more affection than the person
receives (a depressive economy). Blatt (2008) also point out that in some individuals,
characteristics of both anaclitic and introjective types can be present—the mixed config-
uration—a combination which occurs mostly in patients (see Blatt, 2004). Correlations
between dependency and self-criticism scales of the Depressive Experiences Question-
naire assessing, respectively, the anaclitic and introjective depressive personality predis-
positions, tend to be high on clinical samples (see Nietzel & Harris, 1990;Ouimette &
Klein, 1993;Besser, Priel, Flett, & Wiznitzer, 2007).
Several conceptualizations of the depressive personality have emphasized one or more
of three aspects: dependency, masochism, and perfectionism, proposing one or more
depressive personality types. Dependency plus moral masochism, with self-criticism and
guilt resulting from a harsh superego, appear, for example, in the conceptualizations of
Blatt (1974,2004), as well as in the formulation of Kernberg (1988). Blatt also includes
perfectionism as a characteristic of the introjective depressive personality. Rado (1951)
highlights the oral dependency of the depressive personality, manifesting itself in a
craving for protection, love, security, fear of loss, and inhibition of aggression. Chodoff
(1972) and Bemporad (1973) also stress oral dependency. Berliner (1966) and Simons
(1987) highlight the masochist dimension and Laughlin (1956) stresses the presence of
these three aspects. The concept of depressive personality disorder in the appendix of
DSM–IV–TR (American Psychiatric Association, 2002) stresses only introjective charac-
teristics while neglecting those of the anaclitic personality organization—helplessness,
dependency, and fear of abandonment. Characteristics of the depressive personality
disorder include depressed mood, unhappiness, feelings of inadequacy, worthlessness,
self-criticism, tendency to worry, being critical of others, pessimism, and feelings of guilt
and remorse (APA, 2002; see also Ryder, Schuller, & Bagby, 2006).
Despite differences, the different descriptions of the depressive personality share
obvious similarities. It would therefore make sense to create an operationalization, an
empirical definition of depressive personality encompassing broadly different types of
depressive features, to conceptualize and operationalize a unitary depressive personality,
consisting of different depressive traits, that is, different facets.
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603A DEPRESSIVE PERSONALITY CONCEPT
It should be borne in mind, however, that despite a unitary view of depression is
assumed in this manuscript, one can easily find in the literature a non-unitary view (e.g.,
Akiskal, 1989,1997;Coyne, 1994;Santor & Coyne, 2001;Keller & Shapiro, 1982;
Kovacs, Akiskal, Gatsonis, & Parrone, 1994;Schrader, 1994).
A Dimension or a Depressive Spectrum
Depressive personality is a continuum or spectrum, whose extremes can correspond to
many forms of clinical depression as well as to the vulnerability to clinical depression. If
a person has a depressive personality, he or she can have some form of depression, like
a chronic depression, or a vulnerability to moments of depression, and may or may not be
depressed at any specific moment.
The literature seems to support the idea that the depressive phenomenon lato sensu
seems to be a spectrum phenomenon in its intensity, frequency, and duration (Blatt, 2004;
Blatt, D’Afflitti, & Quinlan, 1976;Blatt & Zuroff, 1992;Campos, 2009a;Cox, Enns,
Borger, & Paker, 1999;Cox, Enns, & Larsen, 2001;Flett, Vredenburg, & Kramer, 1997;
Hankin, Fraley, Lahey, & Waldman, 2005;Trull, Widiger, & Guthrie, 1990)—a contin-
uum from normality to pathology. The characteristics of depressed individuals may be
also present in people who are not clinically depressed. Similarly, Jones (1998) argues that
depression may be better represented by dimensional or interpersonal models because
many forms of depression are exaggerations of normal characteristics.
Thus, this paper postulates a dimensional view of depression as a continuum of severity
that transcends various nosological entities as distinct and independent from each other.
Depression as a Trait or as a Set of Personality Traits
Depression is both a set of symptoms that occur in more or less heterogeneous forms in
different clinical conditions, as well as a dimension of normal personality. Assessment of
personality must bear this dimension in mind, regardless of the diagnosis and the intensity
of symptoms present at a given moment. This depressive personality dimension would
consist of a set of different traits exhibited in a wide range of situations and making up a
typical functioning style; the dimension would enable the comparison between individu-
als, the evaluation of interindividual differences.
Personality traits are essential constructs of individual differences (McAdams, 1995;
McAdams & Pals, 2006) as well as explanatory constructs that help to explain interindi-
vidual differences along a continuum. They are general predispositions that can be
expressed differently, yet relatively consistently, across time and context, and are ex-
pressed in different attitudinal, motivational, emotional, and interpersonal styles (see
Lima, 1997;Haslam, 2007;Millon, Grossman, Millon, Meagher, & Ramnath, 2004;Shea
& Yen, 2005).
Similarity Between Depressive Traits and Chronic Depressive Symptoms
It is difficult to distinguish qualitatively between depressive symptoms and traits, but the
difference may lie in their stability and frequency. Low self-esteem, or feelings of
unworthiness, for example, can be a stable personality characteristic or a symptom that
can vary in intensity. As a personality characteristic it can vary in frequency depending on
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604 CAMPOS
life circumstances. The question is, indeed, larger, and can be applied at the diagnosis
level. Distinguishing chronic depression from depressive personality seems to be a
difficult exercise (Ryder et al., 2002), as does discriminating the difference between a
depressive trait and a chronic depressive symptom.
However, it would probably be easier to distinguish between depressive inner expe-
riences of the type delineated in the Depressive Experiences Questionnaire and some
depressive symptoms, especially of the neurovegetative type, such as insomnia, psy-
chomotor retardation and anhergia, but harder to set such inner experiences apart from
more psychologically based symptoms like feelings of worthlessness and loneliness.
Hirschfeld et al. (1989) question the meaning of the term premorbid. “Since subsyndromal
states are likely to be long-lasting, how can these states be separated conceptually and
operationally from abnormalities of personality? Do individuals have abnormal personality
features . . . or do they have chronic (subsyndromal) affective states? Does it make any
difference?” (p. 350). Specifically, Hirschfeld and colleagues question whether neuroticism is
a premorbid disposition or a subsyndromal state of depression. Does the high level of
neuroticism in some individuals who become depressed reflect a spectrum relationship or a
causal relationship between neuroticism as a personality trait and depression?
Klein et al. (1993) questioned the extent that personality traits observed in subaffective
disorders, such as dysthymia or cyclothymia, or even in a borderline personality disorder,
are conceptually different from moderate affective symptoms—to what extent, in a
chronic affective disorder, are we speaking of personality traits or moderate chronic
affective symptoms. In a personality disorder such as borderline personality disorder, are
we looking at chronic mood symptoms or traits of an affective character?
Several authors stress the state-trait difference (e.g., Blatt, 1990,2004;Coimbra de
Matos, 2001,2002;Endler, Macrodimitris, & Kocovski, 2000;Spielberger, 1995). The
distinction between depression and depressive personality would be clear, following the
state-trait model, were only acute depressive disorders considered. But in chronic depres-
sion it is more difficult to distinguish between the depressive illness and the personality
traits that predispose the individual to depressive episodes because, in a significant
percentage of cases, the depression is an exacerbation of the premorbid personality.
It may be that the depressive symptoms are the consequence of both the depressive
state and the predisposition. Rosenbaum, Lewinsohn, and Gotlib (1996) discuss the
possibility that some variables may be both symptoms of depression and stable traits
(observed before and after the depressive episode). Hybrid variables might characterize
individuals when not depressed and be exacerbated in the depressed state. Hartlage,
Arduino, and Alloy (1998) found that variables such as low self-esteem and denial of
dependency (counterdependency) seem to express both components of both state and trait.
Other authors (e.g., Blatt et al., 1976) hypothesize that some depressive characteristics
may be expressed in the depressive state and indicate stable individual differences in a
vulnerability to depression (Franche & Dobon, 1992;Klein, Harding, Taylor, & Dickstein,
1988;Robins, 1995). This would be consistent with a spectrum as well as an etiological
model of the relationship between personality and depression (Klein et al., 2002).
The question is whether, for example, dependency or other personality traits such as
neuroticism, are premorbid for depression as well as part of its symptomatic expression.
Dependency and introversion, for example, are both personality traits as well as depres-
sive symptoms. Depression grafts in personality. Dependency can be both a predisposition
trait as well as an expression of depression.
Klein et al. (2002) questioned whether one can conceptually distinguish depression
from the personality traits associated with it—whether the separation between personality
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605A DEPRESSIVE PERSONALITY CONCEPT
and depression is arbitrary. The differentiation between depressive traits and depressive
symptoms may primarily be in their differential stability, rather than a qualitative matter.
Ritterband and Spielberger (1996) note that trait, state, and symptom of depression are
often confused. State is not the same as symptom. A symptom can be chronic and,
therefore, become part of the functioning of personality, comprising part of the individual,
and then constitute a trait. From this perspective, a symptom can be conceptualized as a
trait when it is stable, as well as being part of the depressive state when it is transient.
Both an etiologic and a phenomenological view of depression should be considered.
From the phenomenological point of view, we can distinguish between a trait and a
symptom mostly based on the duration and frequency. Furthermore, both trait and
symptom can be more or less intense (intensity). The context of manifestation should
mostly be used to characterize symptoms. From the etiologic point of view, on the other
hand, depressive traits can predispose individuals to experience more or less intense,
stable, and frequent depressive symptoms.
Questionnaires to Assess Depressive Personality
Five instruments assessing depressive traits can be found in the literature: the Depressive
Personality Disorder Inventory (DPDI; Huprich, Margarett, Barthelemy, & Fine, 1996;
Huprich, Sanford & Smith, 2002), the Depressive Experiences Questionnaire (DEQ, Blatt
et al., 1976;Blatt, D’Afflitti, & Quinlan, 1979;Zuroff, Quinlan, & Blatt, 1990), the
Depressive Personality Inventory (Eusanio, 1978), the State-Trait Scales for Depression
(Spielberger, 1995), and the State-Trait Depression Adjective Check Lists (ST-DACL,
Lubin, 1994;Riesenmy, Lubin, Van Whitlock, & Penick, 1995).
The DPDI was specifically developed to assess the characteristics associated with a
specific nosological condition, the depressive personality disorder according to the DSM–
IV. Therefore, it operationalizes a specific construct. Hirschfeld et al. (cited by Klein et al.,
1993) state that the core characteristics of depressive personality disorder, as conceptu-
alized in the medical model, seem to be located primarily in the cognitive domain to the
neglect of the interpersonal and affective dimensions.
The DEQ developed by Blatt and colleagues assesses two types of depressive expe-
riences, both anaclitic and introjective. However, this inventory does not include items
related to the affective and somatic aspects of the depressive personality; for example,
features related to a chronic depressed mood such as sadness, dejection, and anhedonia.
Only two studies using the Depressive Personality can be found in the literature
(Eusanio, 1978;Bachelor, Bleau, & Raymond, 1996). It consists of five scales reflecting
the depressive personality unhappy-looking, narcissistic dependency,low self-esteem,
critical mother and dependency promoter father. However, an important limitation can be
drawn. Depressive personality is conceptualized as a very specific construct. Even in a
psychodynamic framework, several characteristics of the construct are not included in this
inventory, especially those relating, for example, to masochism and perfectionism.
The State-Trait Depression Inventory, despite operationalizing the important distinc-
tion between state and trait, also has one major limitation. All of the items refer to
depressed mood, due to the author’s view of depressive phenomenon: trait depression as
a stable tendency to experience dysphoric emotions and not as a set of traits such as low
self-esteem, guilt, dependency, or feelings of loneliness. Endler et al. (2000) suggest that
this instrument may be primarily a measure of negative and positive affectivity. The
State-Trait Depression Adjective Check Lists (ST-DACL) was originally developed to
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606 CAMPOS
measure the emotional aspects of depression (Riesenmy et al., 1995), so similar limitations
can be pointed out.
Summary of the Theoretical Formulation, Aim of the Study, and Predictions
Four fundamental ideas summarize these formulations: (1) it is possible to develop an
empirical definition of a single depressive personality that encompasses a wide range of
depressive features; (2) the depressive personality is a continuum corresponding to the
symptoms of many forms of depression as well as a vulnerability to clinical depression;
(3) depression can be conceptualized not only as an heterogeneous set of symptoms
corresponding to different nosological conditions, but also as a dimension of normal
personality; and (4) the major difference between depressive traits and depressive symp-
toms is stability, not only or mostly their egosyntonic versus egodystonic nature.
Despite the existence of several measures assessing depressive traits, all have in one
way or another limitations as outlined above, especially the fact that some types of
depressive traits are not included. Thus, the development of a measure to assess the
construct of depressive personality in a more comprehensive and holistic form is called
for. This paper presents the effort to develop such a measure.
Such an instrument would bring together the well-established tradition of both psychiatry
and psychoanalysis regarding depressive personality and operationalize a more comprehensive
definition of the depressive personality concept. Psychiatrists have mostly emphasized clinical
manifestations of the condition, while psychoanalysts have focused on inner experience. The
Depressive Experiences Questionnaire, for example, focuses on inner experiences of depres-
sion, but not in traits like chronic depressive mood or anhedonia. On the other hand, the
Depressive Personality Disorder Inventory, developed to measure a psychiatric condition, does
not assess a major aspect of depressive personality according to psychodynamic oriented
models, the anaclitic dimension. Also, contrary to other measures that assume a more or less
qualitative difference between depressive traits and depressive symptoms, the development of
the Depressive Traits Inventory (DTI) will assume duration or stability as the prime criterion
for distinguishing the two. So, as a corollary, someone may have a high score on this inventory
because he or she is chronically depressed.
The major goal for such a new instrument would be to simultaneously assess several
types of depressive traits in clinical populations, but also in nonclinical populations to
identify individuals who may be not depressed but might be at risk.
The DTI will be a trait-like instrument with the instructions asking the respondent to
describe how he or she usually is or behaves, not how the respondent feels or is acting in
the current time. A Likert scale seems to be the most adequate response format, as it is
with other measures assessing personality traits.
After writing the questionnaire items and conducting a preliminary study, the inven-
tory was administered to three nonclinical samples (two college students and a community
sample) and to a clinical sample to study its psychometric characteristics. Cronbach alphas
were computed to test for internal consistency and factor analysis to study the depressive
dimensions assessed by the inventory. Correlations with other depression inventories were
computed to obtain convergent validity data. A comparison between one of the nonclinical
samples and the clinical sample of depressive patients was performed to study criterion-
related validity. The correlation between the DTI results obtained in two different
moments in time were computed to test for test–retest reliability and the correlation of the
DTI with a measure of depression obtained several weeks later was also computed to
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607A DEPRESSIVE PERSONALITY CONCEPT
obtain predictive validity data. Male and female DTI means were compared and the
normality of the empirical distribution of the DTI was also tested.
It was expected that this measure would present several facets/dimensions, and that
women would score higher than men, as usually happens with other measures of depres-
sion. It was also expected that the empirical distribution of the DTI would approach a
normal distribution, since traits are being operationalized and measured. It is also expected
that the new measure would correlate with measures of depressive symptoms and predict
this type of symptoms over time, presenting significant correlations with other trait
depression measures and being internally consistent and stable over time. Finally it was
also expected that depressive patients would score significantly higher.
Method
Development of the Depressive Traits Inventory
The Depressive Traits Inventory (DTI) was developed to operationalize the construct of
depressive personality. The instructions ask the respondent to indicate how he or she
usually is or behaves on a 5-point Likert scale from strongly disagree to strongly agree,
similar to other trait instruments such as the NEO-PI-R (Costa & McCrae, 1992). The
author has thoroughly listed several depressive characteristics presented in the psychiatric
and psychoanalytic literature revised in earlier sections. A total of 96 items were written
for the following traits: depressed mood, pessimism, feelings of failure, anhedonia, guilt,
masochism, self-criticism, lack of meaning and satisfaction with life, indecisiveness, low
self-esteem, lack of energy, irritability, social withdrawal, tendency to worry, tendency to
be critical and to judge others, feelings of discouragement, tendency to feelings of
remorse, feelings of inadequacy, feelings of emotional suffering, helplessness, fear of not
being loved, vulnerability to loss, feelings and difficulties in handling loneliness, depen-
dency on someone, feelings of not being loved or being loved conditionally, depressive
“economy”, submission or resignation, difficulties in handling/expressing aggressive
tendencies, perfectionism, feelings of emptiness, and idealization of the past.
Items were based on clinical descriptions in the literature, composed by the author and
assessed by two more clinical psychologists—to assure representativeness and relevance
(Anastasi & Urbina, 1997). The author also looked at several depressive instruments, like
the Beck Depression Inventory and the Beck Depression Inventory-II, the Depressive
Personality Disorder Inventory, the Depressive Experiences Questionnaire, and the self-
report questionnaire to assess the Depressive Personality Disorder of the Structural
Clinical Interview for the DSM–IV, to inform the writing of these items.
A preliminary study with 349 college students was undertaken. Sixteen items were
eliminated resulting in a final version with 80 items. Means, standard deviations and
corrected item-total correlations for the initial 96-item pool appear in Table 1. Several
procedures were used to study the effectiveness of the items in this preliminary study, such
as the difficulty, the discriminability, the intercorrelations between all items, and the
Cronbach’s alpha (Aiken, 1997;Anastasi & Urbina, 1997;Kline, 1998,2000;Nunnally,
1978;Nunnally & Bernstein, 1994). Items were eliminated if they presented a corrected
item-total correlation lower than .25 or if they correlated excessively with other items as
in the pairs 21/74 and 31/49, with correlations of .70 and .82, respectively. Items 21 and
31 were eliminated according to this criterion. All items considered “too easy” or “too
difficult” (e.g., item 21 and item 38) also had lower corrected item-total correlations and
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608 CAMPOS
were, thus, eliminated, except item 96, which was maintained because it presented a
correlation with the total scale of .40.
Examples of items are: “I find it highly difficult to relax”; “I often feel that people who
are close to me do not give me all the support I need”; “I think most people are not like
they should be”; “Down deep, I don’t think I deserve to be happy”; “I am a person who
needs others a lot”; “In general I don’t much like what I do”; “I often feel lonely”; “I often
think that others are disappointed in me”; “I am a pessimistic person”; “I think my life is
boring and without much interest”; “Down deep, I don’t much like myself”; “I often think
after doing something that I could have done it much better.” The Appendix presents the
80 items of the final form of the inventory.
Validation of the Depressive Traits Inventory: Samples,
Measures, and Procedures
A convenience sample of 546 college students ranging in age between 18 and 55 (M
20.65, SD 3.54) participated in the study. Two hundred and 19 subjects (40.1%) were
Table 1
Results of the Preliminary Version of the Depressive Traits Inventory
Item MSDrItem MSDrItem MSD r
12.67 1.13 .51 33 2.2 .91 .24 65 2.51 .94 .53
22.64 1.17 .35 34 4.14 .84 .19 66 2.66 1.24 .62
33.28 1.8 .28 35 3.6 .9 .17 67 2.76 1.7 .68
42.29 1.4 .35 36 3.87 .84 .28 68 2.4 .97 .33
53.81 1.4 .32 37 2.9 1.6 .52 69 2.61 1.0 .48
62.62 1.9 .53 38 4.24 .67 .22 70 2.7 1.11 .33
72.78 1.6 .34 39 2.65 .97 .70 71 2.37 1.8 .36
82.66 1.3 .46 40 2.54 .95 .43 72 3.92 .88 .11
93.67 .97 .34 41 1.97 .95 .57 73 2.56 1.9 .71
10 3.46 1.15 .58 42 3.41 1.4 .27 74 1.8 1.6 .59
11 3.11 1.3 .41 43 3.29 1.1 .44 75 2.68 .98 .66
12 2.68 1.19 .20 44 2.85 1.18 .61 76 2.67 .94 .27
13 2.29 .95 .52 45 2.5 1.4 .4 77 2.44 1.12 .16
14 2.82 1.26 .30 46 3.22 1.7 .52 78 2.21 .97 .52
15 2.83 1.14 .50 47 2.32 1.7 .51 79 2.54 1.0 .62
16 2.99 1.13 .57 48 3.41 1.5 .14 80 2.3 1.1 .63
17 2.4 .95 .62 49 2.71 1.17 .67 81 2.76 1.8 .51
18 2.68 1.1 .56 50 3.71 .89 .46 82 2.93 1.49 .37
19 2.91 1.14 .62 51 2.27 1.11 .30 83 2.63 1.9 .53
20 3.36 1.14 .44 52 2.64 1.2 .30 84 2.89 1.9 .27
21 1.81 1.17 .5 53 2.86 1.34 .12 85 2.14 .94 .25
22 3.0 1.7 .43 54 3.68 .94 .48 86 3.65 .88 .40
23 3.34 .94 .70 55 3.97 .84 .25 87 3.55 1.2 .5
24 2.8 1.8 .61 56 2.51 1.9 .57 88 2.61 1.1 .36
25 2.31 1.1 .58 57 3.25 .9 .24 89 2.1 .86 .41
26 1.87 .78 .49 58 2.8 1.9 .41 90 2.9 1.9 .51
27 2.73 1.11 .58 59 2.49 1.3 .66 91 2.96 1.14 .36
28 3.32 1.8 .49 60 2.29 .94 .48 92 1.88 .97 .32
29 2.23 1.8 .68 61 2.38 .95 .42 93 2.7 .92 .57
30 1.96 .79 .31 62 3.57 1.8 .51 94 3.35 1.26 .33
31 2.8 1.2 .67 63 3.0 1.26 .3 95 2.68 1.14 .63
32 3.1 2.14 .18 64 3.58 .92 .41 96 1.37 .65 .40
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609A DEPRESSIVE PERSONALITY CONCEPT
male and 327 (59.9%) were female. Participation was voluntary and no compensation was
provided. Students, in groups, responded in random order to the DTI and two more
instruments, the Portuguese version (Campos & Gonçalves, 2011) of the Beck Depression
Inventory-II (Beck, Steer & Brown, 1996) and the Portuguese version (Campos &
Gonçalves, 2006) of the Depressive Personality Disorder Inventory (Huprich et al., 1996),
either at the beginning or at the end of their class. After a brief explanation of the purpose
of the study, participants completed the questionnaires.
A convenience sample of 465 community adults ranging in age between 18 and 65 years
(M35.2, SD 11.3) also participated. Males represented 50.1% and 49.9% were female.
The majority of the participants (more than 95% percent) were Caucasian. Education ranged
from 6 to 19 years (M12.1, SD 3.3). All participants were informally contacted by trained
research assistants and volunteered to participate and gave informed consent. All protocols
were collected in individual sessions by trained research assistants and instructions were
presented in written form. In random order, participants also responded to the Portuguese
version (Gonçalves & Fagulha, 2004) of the Center for Epidemiologic Studies of Depression
Scale (CES-D; Radloff, 1977) and the Portuguese version (Campos, 2009b) of the Depressive
Experiences Questionnaire (DEQ; Blatt et al., 1976).
A clinical sample of 31 patients with depressive disorders (45.2% with major depres-
sion, 48.4% with dysthymic disorder, and 6.4% with depressive disorder not otherwise
specified) participated. Five subjects (16.1%) were male and 26 (83.9%) were female,
ages ranging from 19 to 70 years of age (M37.6, SD 13.8). The mean education level
was 11.2 years. Participants were recruited from the psychiatric department of a Portu-
guese hospital, based on their clinical case record. Criteria for inclusion were: being older
than 18, having a depressive disorder without dementia or other condition that would
invalidate their response to self-report measures. All participants volunteered to partici-
pate and gave informed consent. Protocols were collected in individual sessions and
instructions were presented in written form.
Finally, to examine the test–retest reliability of the questionnaire as well as its predictive
validity, a convenience sample of 40 female college students was used. Ages ranged from 18
to 29 years (M20.08, SD 2.64). Participation was voluntary and no compensation was
provided. Students responded in a group to the DTI and to the BDI-II at the end of one regular
class. After a brief explanation about the purpose of the study, participants completed both
questionnaires. The second administration took place 9 weeks (63 days) after the first, also in
a group at the end of a class. At the second administration, 30 of the 40 initial participants
responded to both questionnaires.
Results
The results obtained by males and females students on the DTI were compared.
Female students (M208.5, SD 45.2) scored significantly higher (t4.35, p
.001) than male students (M191.3, SD 45.2). The results obtained by the
community samples of male and female were also compared. Women (M215.2,
SD 48.7) obtained a significantly higher result (t2.9, p.005) than men (M
202.8, SD 44.8).
To test for the normality of the DTI distribution, the Kolmogorov–Smirnov test
(K–S test), the Lilliefors and the
2
were used. These tests indicated no significant
differences between the empirical distribution and an expected normal distribution
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610 CAMPOS
indicating that the distribution of the DTI was not significantly different from
normality (ps.05).
Reliability
Cronbach’s alpha for the 80 items of DTI was computed. The result was .97 for the student
sample (N546) and also .97 for the community sample. The average interitem
correlation was .29 for both samples.
Convergent Validity
To study the convergent validity of the questionnaire, correlations between the Depressive
Traits Inventory and the Beck Depression Inventory-II (BDI-II; Beck et al., 1996) and the
Depressive Personality Disorder Inventory (DPDI; Huprich et al., 1996) were computed
with the college students’ sample (N546). These values were .70 and .89, respectively,
and were both significant (p.001).
Within the community sample, the correlations between the DTI and the Center for
Epidemiologic Studies of Depression Scale (CES-D; Radloff, 1977) and the Depressive
Experiences Questionnaire (DEQ; Blatt et al., 1976) were also computed. A significant
correlation between the DTI and the CES-D (r.73, p.001) was obtained, confirming
the relationship between depressive traits and depressive symptoms. Despite both being
significant, the correlation was weaker with the dependency scale of the DEQ (r.29,
p.001) than with the self-criticism scale (r.64, p.001).
Factor Structure
To study the factor structure of the DTI, two Principal Components Analyses were
computed separately for the college student sample (N546) and the community sample.
The choice of the number of factors to consider was performed using parallel analysis
(Horn, 1965). In the first case, college student sample, the Principal Components Analysis
revealed six factors. The first seven principal components’ eigenvalues were 24.521,
3.542, 2.574, 1.840, 1.740, 1.652, 1.594, and the first seven eigenvalues for the random
dataset were 1.857, 1.794, 1.746, 1.706, 1.669, 1.636, 1.605, so six factors should be
extracted.
Factors were rotated using Varimax rotation. Note that a Promax rotation was tried
previously since the several facets of the depressive personality concept operationalized
by the inventory could be correlated. However, the factor solution was quite impossible
to interpret, because items loaded simultaneously on several factors, mostly on the first
one, and just a very few items loaded on two of the six factors.
After the Varimax rotation, items with loadings equal to or above .35 were considered to
“belong” to each factor. Using this cut-off, only seven of the 80 items failed to load on at least
one of the factors, and only two items, item 43 and item 79, did not load on one of the factors
using a cut-off of .30; they approached the value, however, with loadings of .29 and .28,
respectively. After the rotation, the six factors explained 44.8% of the variance.
The same procedures were used with the community sample. In this case, six factors
were also obtained. The first seven principal components’ eigenvalues were 25.044, 3.562,
2.455, 2.074, 1.794, 1.748, 1.511, and the first seven eigenvalues for the random dataset
were 1.948, 1.870, 1.817, 1.772, 1.732, 1.695, 1.660, so six factors should be extracted.
Factors were also rotated using Varimax rotation. Items with loadings equal to or above
.35 were considered to “belong” to each factor. After rotation, and together, the five
factors explained 43.70% of the variance.
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611A DEPRESSIVE PERSONALITY CONCEPT
Forty-one of the 80 items loaded on the same factor in both samples distributed by five
factors. Regarding the items that loaded on the five factors, they were called essential
depression,inhibited depression,failure depression, perfectionist depression, and rela-
tional depression. The five factor scales have adequate internal consistency with alphas
ranging between .73 and .93. Examples of items in each scale are: for essential depression,
item 27 “I often lack the courage to live”; and item 66 “I am not a particularly happy
person.” For inhibited depression, item 47 “I generally find it very difficult to make
decisions”; and item 74 “I think my life is boring and without much interest.” For failure
depression, item 16 “I often think that others are disappointed in me”; and item 28, “Down
deep, I don’t much like myself.” For perfectionist depression, item 35 “Many times I think
I have behaved wrongly and feel remorse about what I have done”; and item 41 “I often
think after doing something that I could have done it much better.” Finally for relational
depression, item 38 “I worry a lot that other people may not like me”; and item 51 “I feel
extremely down when I feel rejected or abandoned.”
Criterion-Related Validity
The mean result obtained by the clinical sample was 276.1 (SD 33.47) and is
significantly higher (t7.8, p.001; Cohen’s d.70) than the result obtained by the
community sample (M208.9, SD 4.1).
TestRetest and Predictive Validity
The correlation between scores obtained in the two administrations of the DTI was
significant (r.73, p.001; Cohen’s d2.03). The correlation between the Depressive
Traits Inventory at Time 1 and the Beck Depression Inventory-II at Time 2 (9 weeks later)
was significant (r.64, p.001; Cohen’s d1.62). These results support the predictive
validity of the questionnaire and also the underlying theoretical perspective that depres-
sive traits may predict the occurrence of depressive symptoms.
Discussion
The author has conceptualized and validated a depressive personality concept via the
development and administration of a new inventory, the Depressive Traits Inventory, and
the study of its psychometric properties.
The results of the comparison between male and female participants are consistent
with previous results, systematically reporting gender differences in self-reported mea-
sures of depression (APA, 2000;Beck et al., 1996;Campos, 2009b;Campos & Gonçalves,
2011;Gonçalves & Fagulha, 2004). The empirical distribution of the DTI approached a
normal distribution in both community and student samples, supporting the view that the
inventory measures a trait variable, a psychological dimension with most people obtaining
median results. For other trait measures—for example, the NEO-PI-R (see Costa &
McCrae, 1992), or specifically for a measure of depressive traits like the DEQ (Campos,
2009b)—similar results were obtained. High Cronbach alphas support the internal con-
sistency of the DTI and suggest high homogeneity of the items. However, a mean
interitem correlation of .29 suggests that items are not redundant.
Results support the convergent validity of the DTI. In the student sample the inventory
presented significant correlation with a depressive traits measure and with a measure of
depressive symptoms, respectively, the DPDI and the BDI-II. The significant correlation
between the DTI and the CES-D in the community sample and between the DTI and the
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612 CAMPOS
DEQ scales, which also measure trait dimensions of depression, also support the conver-
gent validity of the questionnaire. Note that the correlation is weaker with the dependency
scale than with the self-criticism scale of the DEQ, as indeed the correlations of these two
DEQ scales are with other measures of depression (see Blatt & Zuroff, 1992). As to be
expected, traits are related with depressive state symptoms at a given time. Also expected
was the significant correlation between the DTI and other measures of trait depression.
However, the correlation value between the DTI and the DPDI (.89) may be overly
high, suggesting at the first glance that the two instruments are redundant. However, in
general, highly correlated scales can provide useful different clinical information (Millon,
1996). In addition, values with a similar magnitude may be common. Huprich et al. (1996)
presents a correlation value between the DPDI and the ATQ-R, a measure of negative
automatic thoughts, of .85.
The significantly different DTI results between the community sample and the clinical
sample also support the validity of the DTI, because it would be expected that patients
with a depressive disorder would present more depressive traits than individuals from a
nonclinical sample, either because they are at increased risk for depressive episodes or
because they present chronic manifestations of depression.
It should be noted that the factor solutions obtained from the student sample and the
community one do not entirely match. This may possibly be due to the fact that the two
samples are quite different. College student samples, on the one hand, are generally
homogenous and can be very different from community samples.
Five dimensions of the depressive personality concept seem to be measured by the
inventory. Even though a coefficient alpha for the scale of .97 was achieved, it is not
entirely certain that the inventory measures a unitary depressive personality style, in part
because several factors were obtained. Following other conceptualizations, more than one
depressive personality type may exist—at least two. For example, according to the
conceptualization of Sidney Blatt, two depressive personality predispositions exist, ana-
clitic and introjective. The present results are not sufficient to elucidate whether there is
a unitary depressive personality with multiple facets or, instead, multiple varieties of a
depressive personality.
Blatt (1974,1990,2004,2008;Blatt & Zuroff, 1992) differentiated two distinct depressive
personalities—a dependent or anaclitic and a self-critical or introjective personality organiza-
tion. These distinction between a depression focused on issues of dependency and another
focused on issues of self-worth and autonomy are also presented in other theoretical formu-
lation including those of Bowlby (1980);Arieti and Bemporad (1980), and Beck (1983).
Kernberg (1970,1988), however, incorporated both anaclitic and introjective elements in a
single concept of a depressive-masochistic personality. Even Blatt (1990,2008;Blatt, Quinlan,
Chevron, McDonald, & Zuroff, 1982) admits the possibility of mixed configurations, in which
both anaclitic and introjective characteristics are present in the same individual. In the
psychiatric tradition, just one form of depressive temperament, related to a basic predisposition
to depression, had been previously described.
This paper does not completely answer the question of whether there is a unitary
depressive personality with several facets or different depressive personalities. However,
it may be relevant to consider the development of an objective instrument to comprehen-
sively assess several types of depressive traits.
In an ancillary analysis, a Principal Components Analysis of the six factors of the question-
naire (second-order analysis) was also performed (using the factor solution of the college sample).
A unique factor, explaining 68.4% of the variance, was obtained. The loadings of the six
factors in this second-order factor, which might be called depressive personality, are: .82,
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613A DEPRESSIVE PERSONALITY CONCEPT
.83, .89, .90, .80, and .70. The questionnaire seems to assess a global dimension or
construct, the depressive personality. However, since the first-order analysis revealed the
existence of several factors, it seems that different facets of a unitary depressive person-
ality can be differentiated.
The significant correlation between DTI results in two different moments supports the
test–retest reliability of the DTI and the fact that DTI measures a stable and trait-like
construct—the depressive personality. The correlation between the DTI at Time 1 and the
Beck Depression Inventory at Time 2 supports the predictive validity of the questionnaire,
and also supports the underlying theoretical perspective assuming that depressive traits
may predispose individuals to experience depressive symptoms.
Conclusion, Limitations and Future Directions
The present results are encouraging and support the validity of the Depressive Trait
Inventory and at the same time of the underlying theoretical concept of depressive
personality. The depressive personality can be understood as a comprehensive and
trait-like construct, a stable dimension with different facets that are related and predict
depressive symptoms and differentiate depressive patients from community participants.
Major limitations of the present study can be, however, pointed out: the small size of
the clinical sample and of the sample used to assess test–retest reliability and predictive
validity. Another limitation may be the fact that all samples are of a convenience type.
Future studies should use larger samples of nonclinical participants and depressive
patients assessed longitudinally, and also take a deeper look at the factor structure of the
instrument. To allow for norms development, more controlled selected samples should be
collected. Futures studies should also address the DTI discriminant validity and also
compare Portuguese and other countries’ samples to study intercultural differences in
depressive traits and in their clinical expression. Intercultural differences do exist when
self-report measures of depressive symptoms are used. Campos (in press) found that male
and female Portuguese young adults scored significantly lower than American young
adults on a self-report measure of depression. Finally it must be acknowledged that while
the DTI was validated in relation to other scales, its real-world significance was not
thereby established.
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618 CAMPOS
Appendix
Final Pool of Items of the Depressive Traits Inventory, Translated Into
English
1—I find it highly difficult to relax.
2—I often feel that people who are close to me do not give me all the support I need.
3—I think most people are not like they should be.
4—I get irritated by anything and everything.
5—I tend to keep mulling over things that people have said or done to me.
6—When I imagine the future I feel that things will not work out for me.
7—I think I’m a quiet person who gets little attention in most situations.
8—I often feel a lack of support from the people around me.
9—I get impatient or irritated when things don’t go according to what I want.
10—Many times I feel that something is missing, something that I can’t define. In
other words, I feel incomplete.
11—I frequently blame myself for things I have said or done to other people.
12—I have often failed at crucial moments in my life.
13—I often sleep poorly.
14—When someone I like becomes angry at me I imagine that the person may not like
me anymore.
15—I often feel lonely.
16—I often think that others are disappointed in me.
17—I find it difficult to see the usefulness of what I do and I think others would do
it better than me.
18—I often feel that I lack the necessary strength to solve problems in life.
19—I am afraid that people I like may distance themselves from me.
20—When I am with other people, it is easier to speak about my imperfections than
my qualities.
21—Down deep, I don’t think I deserve to be happy.
22—I am a person who needs others a lot.
23—In general I don’t much like what I do.
24—I tend to behave inappropriately to situations.
25—I frequently get upset for no specific reason.
26—I am constantly worrying whether I am living up to the expectations of others.
27—I often lack the courage to live.
28—Down deep I don’t much like myself.
29—Few things in life really give me pleasure.
30—I often feel a lack of energy.
31—Even when things are going well, I always imagine that they will end badly.
32—I feel that I owe something to others, so I have to make it up to them somehow.
33—I tend to be very critical of myself.
34—I frequently feel down.
35—Many times I think I have behaved wrongly and feel remorse about what I have
done.
36—There is a great difference between what I am and what I would like to be.
(Appendix continues)
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619A DEPRESSIVE PERSONALITY CONCEPT
37—I have little initiative.
38—I worry a lot that other people may not like me.
39—Even when it is someone else’s fault, I tend to blame myself.
40—Many times I feel empty inside.
41—I often think after doing something that I could have done it much better.
42—I don’t seek a great amount of social contact.
43—I strongly wish that things would return to what they were like when I was a child.
44—For a reason or another, I am always worried about something.
45—It is very difficult to me to say “No” when I am asked for something.
46—I feel little satisfaction from what I have accomplished in my life.
47—I generally find it very difficult to make decisions.
48—I frequently have the impression that I can’t do anything right.
49—I am not a very dynamic person.
50—I have the impression that people only like me when I am or do what they want.
51—I feel extremely down when I feel rejected or abandoned.
52—Even when a relationship is not satisfying or making me happy, I find it very
difficult to end it.
53—I feel the weighed down by the things that I have to do.
54—I have the impression that others see me as a person with few qualities.
55—I am a pessimistic person.
56—I often feel disappointed in myself.
57—I don’t much like novelty or change.
58—I easily resign myself to the negative things that happen to me.
59—On weekends I usually feel more down than during the week.
60—It makes me uncomfortable to fight for my rights when I suffer unfairness and so
I prefer not to do so.
61—I am a sad person.
62—I often feel that my life lacks meaning, that it is not worth living.
63—I sometimes feel that other people don’t like me.
64—I rarely get enthusiastic about what I do.
65—I frequently feel helpless and without the support of other people.
66—I am not a particularly happy person.
67—I rarely feel fully satisfied with what I have.
68—I tend to feel guilty about things that don’t end well.
69—I feel anxiety when I think about the future.
70—I feel that I have already my share of suffering in life.
71—I repeatedly relive in my head things I have said or done.
72—I often feel out of place in certain groups or situations.
73—I feel that I tend to do things more slowly than other people.
74—I think my life is boring and without much interest.
75—I tend to think that others are better than me.
76—It is hard for me to get started when I have to begin something.
77—Everyone gets what she or he deserves, and in some way I deserve the bad things
that have happened to me.
78—While others are having fun, I simply pass the time.
79—It is hard to be alone.
80—I rarely feel really good or laugh freely.
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620 CAMPOS
... The Depressive Traits Inventory (DTI) [26,27]. The DTI is an 80 item self-report questionnaire that assesses a wide range of depressive traits and was constructed based on the psychiatric and psychoanalytic literature regarding depressive personality. ...
... In the present study only the total scale score was used. The DTI presents adequate psychometric properties, namely internal consistency and predictive validity (see Campos, 2013) [27]. Examples of items include: "I am a sad person"; "It is hard to be alone"; "I frequently blame myself for things I have said or done to other people"; "I often feel that people who are close to me do not give me all the support I need". ...
... In the present study only the total scale score was used. The DTI presents adequate psychometric properties, namely internal consistency and predictive validity (see Campos, 2013) [27]. Examples of items include: "I am a sad person"; "It is hard to be alone"; "I frequently blame myself for things I have said or done to other people"; "I often feel that people who are close to me do not give me all the support I need". ...
... Despite its limitations, data of the present investigation might have important clinical implications for the treatment of depressive disorders. Firstly, although the clinical relevance of these results remains to be further established, these findings are of particular importance in light of the fact that other studies have demonstrated the clinical validity and utility of the depressive personality construct (Phillips et al., 1990;Huprich, 1998Huprich, , 2012Phillips and Gunderson, 1999;Westen and Shedler, 1999a,b;Ryder et al., 2006Ryder et al., , 2010Chamberlain and Huprich, 2011;Campos, 2013). Secondly, as in other research (Ouimette et al., 1994;, this investigation seems to suggest that self-criticism might be involved in a broader range of psychopathology, raising the possibility that this construct may be a relatively non-specific marker of general psychopathology. ...
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