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Organizacja osobowości u osób uzależnionych od alkoholu i narkotyków
Abstract
Podstawy teoretyczne. Strukturalny model poziomów organizacji osobowości
Ottona F. Kernberga jest szeroko wykorzystywaną przez klinicystów
koncepcją, weryfikowaną w badaniach z udziałem grup klinicznych
i nieklinicznych. Koncepcja ta skupia się na wyjaśnianiu źródeł i patomechanizmów
leżących u podłoża zaburzeń psychicznych w kategoriach patologicznej
struktury osobowości. Strukturalną patologię osobowości klasyfikuje
się na podstawie właściwości najważniejszych struktur wyższego
rzędu i procesów psychicznych, do których należą: (i) tożsamość, (ii) charakter
relacji z obiektem, (iii) mechanizmy obronne, (iv) badanie rzeczywistości
i (v) funkcjonowanie moralne. Na ich podstawie dokonuje się w modelu
Kernberga oceny strukturalnej, pozwalającej na scharakteryzowanie nasilenia
patologii osobowości na trzech poziomach: (i) neurotyczna organizacja
osobowości, (ii) organizacja osobowości borderline wysokiego poziomu, (iii)
organizacja osobowości borderline niskiego poziomu oraz – dodatkowo – na
charakterystykę zdrowej osobowości.
Cel badania. Celem prezentowanego badania było porównanie osób
uzależnionych od alkoholu oraz narkotyków z grupą osób bez uzależnienia
pod względem organizacji osobowości.
Grupa badana. Badania zostały przeprowadzone w grupie 207 osób,
w tym 64 osoby były uzależnione od alkoholu (53 mężczyzn i 9 kobiet), 75 –
od narkotyków (60 mężczyzn i 15 kobiet), a grupę pozostałych 68 osób stanowiły
osoby bez uzależnienia (50 mężczyzn i 18 kobiet).
Metoda. W badaniach zastosowano Inwentarz organizacji osobowości (IOO;
Inventory of Personality Organization) Clarkina, Foelscha i Kernberga (2001),
w polskiej adaptacji Izdebskiej i Pastwy-Wojciechowskiej (2013).
Wyniki. Zgodnie z założeniami rezultaty badań wykazały, iż zarówno
osoby uzależnione od alkoholu, jak i uzależnione od narkotyków charakteryzuje
istotnie silniejsza ogólna patologia organizacji osobowości niż osoby
nieuzależnione. Osoby uzależnione od substancji psychoaktywnych cechują
się znacząco wyższym poziomem dyfuzji tożsamości, niedojrzałych mechanizmów
obronnych, trudnościami w zakresie badania rzeczywistości, a także
większą patologią funkcjonowania moralnego i wyższym poziomem agresji.
Ponadto w badaniach nie odnotowano żadnych związków między organizacją
osobowości i jej poszczególnymi wymiarami a długością uzależnienia
od alkoholu i narkotyków.
Wnioski. Przeprowadzone badania wykazały, że w przypadku osób uzależnionych
od alkoholu oraz uzależnionych od narkotyków można wnioskować
o zwiększonej tendencji do przejawiania deficytów w zakresie organizacji
osobowości, co kieruje uwagę na zagadnienie prawdopodobnie niedostatecznej
diagnostyki zaburzeń osobowości wśród pacjentów uzależnionych od
substancji psychoaktywnych.
Introduction. Otto F. Kernberg’s structural model of personality organization
is a concept widely used by clinicians, verified in studies involving clinical
and non-clinical groups. This concept focuses on explaining the mechanisms
underlying mental disorders in terms of pathological personality structure. Pathology
of personality organization is classified on the basis of the properties
of the most important structures and mental processes, which include: (i) identity,
(ii) the nature of the relationship with the object, (iii) defense mechanisms,
(iv) capacity for reality testing and (v) moral functioning. Based on this, the
severity of personality pathology is assessed at three levels: (i) neurotic personality
organization, (ii) high-level borderline personality organization, (iii) low-
level borderline personality organization.
Aim of the study. The aim of this study was to compare alcohol and drug
dependent persons with a group of persons without dependence in terms of
personality organization.
Participants. The study participants were 207 persons, including 64 alcohol
dependent persons (53 men and 9 women), 75 drug dependent persons (60 men
and 15 women) and the 68 non-dependent persons (50 men and 18 women).
Method. In the study the Inventory of Personality Organization (in the
Polish adaptation of Izdebska and Pastwa-Wojciechowska) was used for data
analysis.
Results. The results of the research showed that both alcohol and drug dependent
persons are characterized by a significantly stronger pathology of personality
organization than non-dependent persons. Dependent persons are characterized
by a significantly higher level of identity diffusion, primitive defense
mechanisms, difficulties in capacity for reality testing, as well as a greater pathology
of moral functioning and a higher level of aggression. In addition, the
study did not report any relationship between dimensions of personality organization
and the length of alcohol and drug dependence.
Conclusions. The research showed that in the case of alcohol and drug
dependent persons it can conclude that there is an increased tendency to manifest
deficits in the personality organization, which directs attention to the
issue of probably insufficient diagnosis of personality disorders among alcohol
and drug dependent patients.
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Objectives: Previous research work suggests a positive association between secure attachment and increased therapy adherence (TA) in different patient groups. However, there is still a strong need for research focusing on the influence of attachment on TA in substance use disorder (SUD) treatment. Hence, this study attempts to investigate the predictive value of different attachment patterns concerning TA in SUD inpatients. Results: 122 (34 female) SUD inpatients completed the Attachment Style Questionnaire (ASQ) during the entry phase of therapeutic community treatment. After 6 weeks, subjects who remained in therapy (n = 47) completed the ASQ for a second time. In line with the literature, agglomerative Cluster Analysis suggested a two-cluster solution
(Cluster I: increased secure attachment pattern; Cluster II: increased insecure attachment pattern). Notably, inpatients in Cluster I were more likely to drop out of treatment within the first 6 weeks (p < .001). Furthermore, subjects showed less “Confidence in Self and Others” (p < .05) after 6 weeks of treatment. Our findings indicate a negative predictive value of increased attachment security for TA in SUD inpatients. This finding probably mirrors a more realistic kind of self-assessment. More generally, the importance of considering attachment styles in SUD treatment is underlined.
Background:
Literature has demonstrated the adaptive function of identity development and parenting toward manifestation of problem behaviors in adolescence. These dimensions act on both internalizing and externalizing symptoms.
Methods:
The objective is to investigate the relationship between identity status, parenting, and adolescent problems, which may manifest through internalized (phobias, obsessions, depression, eating disorders, entropy) and externalized modes (alcohol use and school discomfort). The research involved 198 Italian students (104 males and 94 females) in the 4th year (mean =16.94 years, standard deviation =0.35) and 5th year (mean =17.94 years, standard deviation =0.43) of senior secondary schools, who live in Caltanissetta, a town located in Sicily, Italy. The research lasted for 1 school year. The general group consisted of 225 students with a mortality rate of 12%. They completed an anamnestic questionnaire to provide 1) basic information, 2) alcohol consumption attitude in the past 30 days, and 3) their beliefs about alcohol; the "Ego Identity Process Questionnaire" to investigate identity development; the "Parental Bonding Instrument" to measure the perception of parenting during childhood; and the "Constraints of Mind" to value the presence of internalizing symptoms.
Results:
Data show that identity status influences alcohol consumption. Low-profile identity and excessive maternal control affect the relational dependence and the tendency to perfectionism in adolescents. Among the predictors of alcohol use, there are socioeconomic status, parental control, and the presence of internalizing symptoms.
Conclusion:
Family is the favored context of learning beliefs, patterns, and values that affect the broader regulatory social environment, and for this reason, it is considered the privileged context on which to intervene to reduce the adolescents' behavior problems. This deviance could be an external manifestation of the difficulty in management of internalizing symptoms in adolescence.
The Inseparable Nature of Love and Aggression: Clinical and Theoretical Perspectives By Otto F. Kernberg. American Psychiatric Publishing. 2012. £39.00 (pb). 380 pp. ISBN: 9781585624287
This fascinating book is a collection of papers by the American psychiatrist and psychoanalyst Otto F. Kernberg
errata: W Tabeli 3. pojawił się błąd dotyczący kolejności skrótów odnoszących się do trzech organizacji osobowości (opis w tekście oraz wartości podane w tabeli są prawidłowe). Prawidłowa kolejność to: PNB, PBN, PBN, PNB. Prawidłowa wersja tabeli dostępna do pobrania w pliku pdf jako dodatek do artykułu.
This article presents pilot study verifying the assumption of O. Kernberg’s object relation theory concerning psychotic, borderline and neurotic personality organization. Three personality organization were characterized by the level of diffusion or integration identity, by dominance of primitive defensive operation centering around splitting or deny and by capacity for reality testing. These variables were tested by the following methods: Objective Measure of Ego-Identity Status (Adams, Bennion, Huh, 1989), Strength Ego (Barron, 1953) and Inventory of Defense Mechanisms (Gleser, Ihilevich, 1969) The research involved 30 patients with clinical diagnosis psychotic disorders (schizophrenic, psychotic disorders), 30 with anxiety disorders and neurosis and 30 with borderline personality disorder (assess by Leichsenring’s BPI). These groups was compared. The discriminative analyses show that three variables: diffusion identity, level of primitive or were mature defense mechanisms and capacity for reality testing explain about 67-87% qualification to one of three different groups of pathological personality organization.
This paper summarizes findings and clinical implications of research on attachment disorganization in diverse clinical groups. Disorganized/unresolved attachment is overrepresented in these groups compared to healthy control participants, but disorder-specific characteristics of this attachment pattern are still poorly understood. The focus of this study was to explore defensive processes in participants whose narratives were classified as disorganized/unresolved using the Adult Attachment Projective Picture System (AAP). Besides the predominance of disorganized attachment, clinical participants demonstrated more "segregated system material" especially in stories representing aloneness and more "Personal Experience material" compared to healthy individuals. Within the disorganized/ unresolved clinical individuals, BPD and PTSD patients showed the highest proportion of attachment disorganization and were less able to use other attachment-related defenses to maintain organized. Furthermore, PTSD patients were emotionally overwhelmed by the projective attachment scenes compared to the other clinical groups as indexed by an incapacity to complete sections of the AAP. BPD and addicted patients were characterized by a high degree of self-other boundary confusion. Depressive and schizophrenic patients showed a high overall defensive intensity to remain organized. Attachment theory (Bowlby, 1969) provides a powerful framework for understanding the close relationships between mental representations of self and others with subsequent patterns of emotion regulation, trauma and Corresponding author: florian.juen@uibk.ac
Background
Insecure early attachment experiences have been reported to play an important role in the manifestation in alcoholism. The purpose of this study was to investigate the relationship of attachment styles with anxiety, anxiety coping and dysfunctional personality styles, as well as with the prevalence of personality disorders, and adverse life-events in adolescence.
Methods
59 inpatient alcohol addicted male (n=43) and female (n=16) patients were characterized by an attachment style scale (Relationships-style-questionnaire-RSQ) and completed a questionnaire battery comprising the State-Trait-Anxiety-Inventory (STAI), the Anxiety-Coping-Inventory (ABI), Temperament-and-character-inventory (TCI), Personality-system-interaction-inventory (PSI), and gave information on sociodemography, alcohol history, and adolescent adverse events. A structured interview (SKID-II) was performed to diagnose personality disorders.
Results
Only 33% of subjects had a secure attachment style. Insecure attachment was associated with significantly higher trait-anxiety, higher cognitive avoidance to control anxiety, and higher values on most personality style dimensions directed to the pathological pole.
Conclusions
Despite the limitation due to a small sample size, the results of this study show that the consideration of attachment styles is of significance in the diagnosis and therapy of alcohol addiction. Attachment may characterize different styles to control emotional aspects, anxiety cues and interpersonal relationships in individuals suffering from alcohol addiction.
To investigate the protective role of personal identity consolidation against health risk behaviors in college-attending emerging adults.
A multisite sample of 1546 college students completed measures of personal identity consolidation and recent risk behavior engagement.
Multivariate Poisson regression indicated that personal identity consolidation was negatively related to binge drinking, illicit drug use, sexual risk behaviors, and risky driving. These findings were consistent across gender, ethnicity, and place of residence.
A consolidated sense of personal identity may protect college-attending emerging adults from health-compromising behaviors. Health professionals could incorporate an identity development component into college health programming.
Attachment, fear of intimacy and differentiation of self were examined by means of self-report questionnaires in 158 volunteers, including 99 clients enrolled in addiction treatment programs. As expected, clients (who were undergoing treatment for alcoholism, heroin addiction, amphetamine/cocaine addiction or cannabis abuse) reported higher levels of insecure attachment and fear of intimacy, and lower levels of secure attachment and differentiation of self, compared to controls. Insecure attachment, high fear of intimacy and low self-differentiation appear to characterize clients enrolled in addiction treatment programs. Such characteristics may reflect a predisposition to substance problems, an effect of chronic substance problems, or conceivably both.
We tested the hypotheses that adolescents with few positive and many negative self-schemas would drink and get drunk earlier than adolescents with many positive and few negative selfschemas. Adolescents (N=264) from an ongoing prospective family study of alcoholism [Zucker,R. A., Fitzgerald, H., Refior, S., Puttler, L., Pallas, D., & Ellis, D. (2000). The clinical and social ecology of childhood for children of alcoholics: Description of a study and implications for a differentiated social policy. In H. Fitzgerald, B. Lester, & B. Zuckerman (Eds.), Children of addiction: Research, health, and policy issues (pp. 109???141). New York, NY: Routledge Falmer]
were assessed at ages 12 to 14 and again at ages 15 to 17. When considering the combined
effects of the number of positive and negative self-schemas, antisociality, and parental alcoholism on drinking outcomes, the number of negative self-schemas directly predicted early drinking onset, whereas the number of positive self-schemas moderated the effects of antisociality on early drunkenness. Moreover, although self-concept properties at baseline did not differentiate level of alcohol involvement at follow-up in mid-adolescence, they did distinguish earlier from later age of onset among those who initiated, with effects tending to be
somewhat stronger for boys than girls. Self-schemas appear to be an additional risk factor in the pathway to problem alcohol involvement in adolescence, above and beyond the contributions of such known risk factors as antisocial behavior and parental alcoholism.
This study investigated personality traits and defense styles in order to determine clinical specificities and predictive factors of alcohol use disorders (AUDs) in women. A female sample, composed of AUD outpatients (n = 48) and a control group (n = 50), completed a sociodemographic self-report and questionnaires assessing personality traits (BFI), defense mechanisms and defense styles (DSQ-40). Comparative and correlational analyses, as well as univariate and multivariate logistic regressions, were performed. AUD women presented with higher neuroticism and lower extraversion and conscientiousness. They used less mature and more neurotic and immature defense styles than the control group. Concerning personality traits, high neuroticism and lower conscientiousness were predictive of AUD, as well as low mature, high neurotic, and immature defense styles. Including personality traits and defense styles in a logistic model, high neuroticism was the only AUD predictive factor. AUD women presented clinical specificities and predictive factors in personality traits and defense styles that must be taken into account in AUD studies. Implications for specific treatment for women are discussed.
Background:
Previous research has linked insecure attachment styles and borderline personality organization to substance use disorder (SUD). However, it still remains unclear whether those impairments apply to different kinds of SUDs to the same extent. Therefore, in this study we sought to investigate potential differences regarding attachment deficits and borderline personality organization in two different SUD inpatient groups and furthermore in comparison to healthy controls.
Sampling and methods:
A total of 66 (24 female) inpatients diagnosed with alcohol use disorder (AUD), 57 (10 female) inpatients diagnosed with polydrug use disorder (PUD), and 114 (51 female) healthy controls completed the Borderline Personality Inventory and the Attachment Style Questionnaire.
Results:
Compared to healthy controls, AUD and PUD inpatients showed significant deficits in all attachment parameters (p < 0.01) as well as a significantly increased amount of borderline personality organization (p < 0.01). No differences between AUD and PUD inpatients were observed (p > 0.05).
Conclusions:
Our results indicate that the drug(s) of choice cannot be regarded as an indicator for the extent of attachment deficits or personality pathology. These initial findings are mainly limited by the rather small sample size as well as just a single point of measurement. Future research might also consider further covariates such as comorbidity or psychotropic medication.
The structure of personality and tools for its assessment constitute an important issue within the theories that belong to the psychoanalytic paradigm. The article presents the conceptualisation of the structure of personality introduced by Kernberg, as well as a diagnostic method based on this model – the Inventory of Personality Organization. The construction of the inventory and the results of the research (N = 575) conducted in Polish adaptation of its American version (Clarkin, Foelsch, Kernberg, 2001) are presented. The psychometric characteristics, both of the original version and the Polish adaptation, are satisfactory. [article in Polish]
Objectives
This study aims to evaluate different kinds of temperament and attachment in a sample of alcohol-dependent patients, divided in Cloninger typology 1 and 2, compared to an healthy group.
Materials and procedure
A group of 40 patients was recruited, in a 3 months period, from Alcohology Unit of “Villa Rosa” in Viterbo. This sample was selected by a clinical diagnosis of Alcohol Dependence and compared to a control group of 40 healthy subjects. Each participant was screened by: SCID-I for Axis I Diagnosis, SCID-II for Axis II Diagnosis, TEMPS-A for Temperament, ECR for Attachment Styles.
Results
Statistical analysis showed significative differences between the two groups ( p < 0.05). The mean of the scores ( t Student) and the Mann-Whitney U test results higher in the experimental group. Regarding the ECR, we found differences in the “avoidance” between Cloninger's typology 1 and 2. Control group: 92.5% of the subjects showed a “secure” attachment, 7.5% a “dismissing” attachment. Experimental group: 40% of the sample showed a “secure” attachment, 35% a “dismissing” attachment, 17.5% a “preoccupied” attachment and 7.5% a “fearful/avoidant” attachment.
Discussion
Our sample showed that the “preoccupied” and the “dismissing” attachment styles were the most prevalent among alcoholists, while the “secure” style was typical of control subjects. Concerning the TEMPS-A we found high prevalence of the hyperthymic and cyclothymic temperaments.
Very few researches concerning women addictions are done up to day. This paper tries to define basic similarities and differences in defense mechanisms used by women alcohol and opiate addicts.
Method
Sample of alcohol and opiate female addicts (30 patients in each group) plus control group (30 women) with no psychiatric diagnosis were questioned with Defense Style Questionnaire - DSQ 40 (Andrews, Singh, Bond, 1993).
Results
There were found no statistically relevant differences between two experimental and one control group concerning mature defense mechanism use. Significant differences were found in neurotic and immature defense mechanism use: alcohol addicts use prevalently neurotic mechanisms and immature mechanisms prevail among opiate addicts.
Conclusions
In our research mostly used neurotic defense mechanisms by alcohol addicts were: pseudoaltruism, idealization, and undoing. The mostly used immature defense mechanisms among opiate addicts were: phantasy, isolation, devaluation, denial and splitting.
A high co-occurrence between personality and substance use disorders suggests causal relationships between these conditions. Most empirical evidence strongly supports causal pathways in which (pathological) personality traits contribute to the development of a substance use disorder (i.e., primary personality disorder model). In addition, data support a heuristic model of three developmental pathways, that is, the behavioural disinhibition, stress reduction, and reward sensitivity pathways. No data from prospective studies are available on the primary substance use disorder model. It is therefore unknown as to what extent high Axis II prevalences in addicts can be accounted for by personality disorder symptoms resulting from (chronic) substance abuse. Finally, recent empirical findings with respect to the common factor model suggest a common diathesis for substance use disorder and antisocial personality disorder. In any individual case, more than one model may have explanatory value. It is possible that one model best describes the initiation of a comorbid disorder, while another describes long-term maintenance of the same comorbid association. Personality pathology may also act as a modifier of symptoms, treatment response, outcome, and course of substance use disorder, and thereby account for the strong association between both conditions. This possibility does not involve a causal relationship but may have important implications for treatment planning.
Objectives:
This study examined the roles of identity formation and moral identity in predicting college student mental health (anxiety and depressive symptoms), health-risk behaviors (hazardous alcohol use and sexual risk taking), and psychological well-being (self-esteem and meaning).
Method:
The sample comprised 9,500 college students (aged 18-25 years, mean = 19.78, standard deviation = 1.61; 73% female; 62% European American), from 31 different universities, who completed an online self-report survey.
Results:
Structural equation models found that identity maturity (commitment making and identity synthesis) predicted 5 of the health outcomes (except sexual risk taking), and moral identity predicted all of the health outcomes. In most cases identity maturity and moral identity also interacted in predicting mental health and psychological well-being, but not health-risk behaviors.
Conclusions:
The maturity and specific contents of identity may both play unique and often interactive roles in predicting college student health. Thus, college student health might be bolstered by helping them establish appropriate identity commitments.
The study examined the effects of ego identity status, matriculation level, and gender on alcohol consumption, alcohol expectancies, and drinking refusal self-efficacy. Male (n = 64) and female (n = 114) undergraduate students at a 4-year college were surveyed and classified into four identity status categories. Data on alcohol expectancies, drinking refusal self-efficacy, and quantity and frequency of alcohol consumption were obtained. Results of the ANOVA for alcohol consumption in males supported research that indicates ego identity status affects consumption levels. Identity foreclosed males consumed greater quantities of alcohol than did males classified in moratorium status. Ego identity status did not significantly affect consumption levels in females. Although the results of the multivariate statistics for the variables of interest did not reveal significant interaction effects, several main effects for gender and matriculation level were noted. These findings are discussed in terms of prevention and education efforts on college campuses. Analyses suggested multifactor interventions designed specifically to enhance drinking refusal self-efficacy, expectancy challenges, and psychosocial maturity will affect consumption levels and behavior patterns in undergraduate students.
An integration of psychoanalytic theory with contemporary developments in cognitive neuroscience offers a useful perspective on long-standing controversies about the nature of transference, and a better understanding of the precise mechanisms by which transferential processes occur. Contemporary psychoanalytic views of transference are reviewed, and the many processes that constitute transference are described. Two issues that have emerged in different guises for several decades-the role of the analyst in eliciting transference, and the nature of "real" and "transferential" components of the therapeutic relationship-are reconsidered in the light of concepts such as connectionist networks. Although a useful analytic stance is one that allows the patient's enduring dynamics to dominate the analytic field, it is suggested, anonymity is neither a cognitive possibility nor the driving force behind most transference reactions, and the distinction between "real" and "transferential" perceptions is one of therapeutic interest, not of mechanism. Certain features of the analytic situation make some dynamics more likely than others to enter the treatment relationship, notably those related to authority, intimacy and attachment, and sexuality. Transference reactions are best understood as constructed from a combination of the patient's enduring dispositions to react in particular ways under particular conditions; features of the analytic situation and of the analyst; and interactions between patient and analyst. These reactions do not unfold ineluctably from the patient's mind in the consulting room, nor are they cognitive constructions of the patient-analyst dyad or co-constructions of relatively equal partners exerting their influence on the analytic field.
First-year college students were asked to complete alcohol consumption and identity status questionnaires-currently and retrospectively. Trend analyses of the retrospective data and current data revealed somewhat similar inverse linear trends for identity status on absolute annual alcohol consumption. In both cases, identity sophistication was associated with lower levels of consumption. Of the students who reported an increase in consumption from the junior year of high school to the first year of college, those displaying progressive identity development reported a relatively lower increase in consumption than those displaying stable identity status. This difference approached the conventional level of significance. The implications of these findings are explored.
Despite the fact that addiction has often been identified as an attachment disorder, empirical studies on this topic are rather scarce. In our study we explore attachment style (secure vs. insecure) in alcoholic inpatients and its relationship with perceived parenting and alcohol-related and psychiatric problems in a sample of 101 alcoholic inpatients (Belgium). Our results reveal that in comparison to the securely-attached group, insecurely-attached alcoholic inpatients perceived their mother as more controlling, reported more severe psychiatric problems in the European Addiction Severity Index, had higher scores on the Beck Depression Inventory, showed more schizotypal and depressive personality traits and had more difficulties with communicating emotions (alexithymia). We argue that it makes sense to differentiate alcoholic inpatients on the basis of attachment style and that both groups (secure/insecure) need different treatment approaches.
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