Benedicte Lowyck

Process and outcome in psychodynamic hospitalization-based treatment for patients with a personality disorder.

This study examined the relationship between the psychotherapeutic process and outcome in 44 patients who completed hospitalization-based psychodynamic treatment for personality disorders. Using self-report and interview ratings, outcome was assessed in terms of symptoms and personality functioning, and the psychotherapeutic process in terms of self and object relations, felt safety, and reflective functioning. Symptom and process measures were administered at intake, every 3 months during treatment, and at 3 and 12 months follow-up. Personality measures were collected at intake, the end of treatment, and at 3 and 12 months follow-up. Using Piecewise Linear Growth Curve Analysis results showed improvement in symptoms, personality functioning, self and object relations and felt safety, but not in reflective functioning. Linear changes in self and object representation and felt safety, but not in reflective functioning, predicted improvement in outcome.

Outcome and Outcome Trajectories of Personality Disordered Patients During and After a Psychoanalytic Hospitalization-Based Treatment

This study aims to identify different outcome trajectories in a psychoanalytic hospitalization-based treatment in a sample of 70 patients with personality disorders using a naturalistic 12 month follow-up design. Trajectory analysis identified four groups of patients, i.e., patients showing (a) high initial symptom levels and considerable and consistent improvement late in treatment (High-Low group; HL), (b) medium initial symptom levels and a quick and sustained response (Medium-Low group; ML), (c) medium initial symptom levels but without substantial improvement (Medium-Medium group; MM), and (d) low initial symptom levels without substantial further improvement during and after treatment (Low-Low group; LL). Further, data suggested that these four trajectories were related in theoretically meaningful ways to pre-treatment variables, such as anaclitic and introjective personality styles and trauma. Results are discussed in the context of other studies showing the need for differential treatment approaches based on pretreatment characteristics.

Development and validation of a self-report measure of mentalizing: The Reflective Functioning Questionnaire

Reflective functioning or mentalizing is the capacity to interpret both the self and others in terms of internal mental states such as feelings, wishes, goals, desires, and attitudes. This paper is part of a series of papers outlining the development and psychometric features of a new self-report measure, the Reflective Functioning Questionnaire (RFQ), designed to provide an easy to administer self-report measure of mentalizing. We describe the development and initial validation of the RFQ in three studies. Study 1 focuses on the development of the RFQ, its factor structure and construct validity in a sample of patients with Borderline Personality Disorder (BPD) and Eating Disorder (ED) (n = 108) and normal controls (n = 295). Study 2 aims to replicate these findings in a fresh sample of 129 patients with personality disorder and 281 normal controls. Study 3 addresses the relationship between the RFQ, parental reflective functioning and infant attachment status as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. In both Study 1 and 2, confirmatory factor analyses yielded two factors assessing Certainty (RFQ_C) and Uncertainty (RFQ_U) about the mental states of self and others. These two factors were relatively distinct, invariant across clinical and non-clinical samples, had satisfactory internal consistency and test–retest stability, and were largely unrelated to demographic features. The scales discriminated between patients and controls, and were significantly and in theoretically predicted ways correlated with measures of empathy, mindfulness and perspective-taking, and with both self-reported and clinician-reported measures of borderline personality features and other indices of maladaptive personality functioning. Furthermore, the RFQ scales were associated with levels of parental reflective functioning, which in turn predicted infant attachment status in the SSP. Overall, this study lends preliminary support for the RFQ as a screening measure of reflective functioning. Further research is needed, however, to investigate in more detail the psychometric qualities of the RFQ.

The Impact of Level of Personality Organization on Treatment Response: A Systematic Review

This paper provides a systematic review of extant research concerning the association between level of personality organization (PO) and psychotherapy response. Psychotherapy studies that reported a quantifiable association between level of PO and treatment outcome were examined for eligibility. Based on stringent inclusion and exclusion criteria, we identified 18 studies from 13 original data sources. Participants in these studies had a variety of mental disorders, of which mood, anxiety, and personality disorders were the most common. The results of this systematic review converge to suggest that higher initial levels of PO are moderately to strongly associated with better treatment outcome. Some studies indicate that level of PO may interact with the type of intervention (i.e., interpretive versus supportive) in predicting treatment outcome, which suggests the importance of tailoring the level of interpretive work to the level of PO. Yet, at the same time, the limited number of studies available and the heterogeneity of measures used to assess PO in existing research stress the need for further research. Potential implications for clinical practice and guidelines for future research are discussed.

Well-being and relationship satisfaction of couples dealing with an in vitro fertilization/ intracytoplasmic sperm injection procedure : a multilevel approach on the role of self-criticism, dependency, and romantic attachment

OBJECTIVE To extend existing research on the psychological impact of IVF by studying the association between the psychosocial factors of self-criticism and dependency, and romantic attachment, with the well-being and relationship satisfaction of couples across the different phases of IVF/intracytoplasmic sperm injection (ICSI) treatment. DESIGN Prospective, three-wave study (i.e., from start of IVF/ICSI treatment, to 3- and 6-month follow-up). SETTING University hospital. PATIENT(S) Seventy couples in IVF/ICSI treatment. INTERVENTION(S) Psychometric tests were administered at first visit of IVF/ICSI treatment, and at 3- and 6-month follow-up. MAIN OUTCOME MEASURE(S) Psychological well-being, relationship satisfaction. RESULT(S) Results demonstrated that preexisting psychosocial factors such as self-criticism, dependency, and romantic attachment are more important factors for psychological well-being and relationship satisfaction during IVF/ICSI than gender and treatment-related factors such as duration of fertility problems. In addition, multilevel analysis, a statistical method that is required for the analysis of longitudinal couple data and decomposes variation in three levels (i.e., time, individuals, and couples), showed more variation in psychological well-being and relationship satisfaction between couples, than between individuals and different time measurements. CONCLUSION(S) Preexisting personality factors and being embedded within a certain couple relationship are important factors for the psychological well-being and relationship satisfaction during IVF/ICSI.

The Construct Validity of the Dutch Personality Inventory for DSM-5 Personality Disorders (PID-5) in a Clinical Sample:

The factor structure and the convergent validity of the Personality Inventory for DSM-5 (PID-5), a self-report questionnaire designed to measure personality pathology as advocated in the fifth edition, Section III of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), are already demonstrated in general population samples, but need replication in clinical samples. In 240 Flemish inpatients, we examined the factor structure of the PID-5 by means of exploratory structural equation modeling. Additionally, we investigated differences in PID-5 higher order domain scores according to gender, age and educational level, and explored convergent and discriminant validity by relating the PID-5 with the Dimensional Assessment of Personality Pathology—Basic Questionnaire and by comparing PID-5 scores of inpatients with and without a DSM-IV categorical personality disorder diagnosis. Our results confirmed the original five-factor structure of the PID-5. The reliability and the convergent and discriminant validity of the PID-5 proved to be adequate. Implications for future research are discussed.

LEVELS OF PERSONALITY FUNCTIONING AND THEIR ASSOCIATION WITH CLINICAL FEATURES AND INTERPERSONAL FUNCTIONING IN PATIENTS WITH PERSONALITY DISORDERS

Recently, the DSM-5 Personality and Personality Disorders Work Group has proposed a multiple level approach toward the classification and diagnosis of personality disorders (PDs), with the first level entailing a rating of impairments in levels of personality functioning. Although a number of measures that assess levels of personality functioning have been validated, given its prominent status in the DSM-5 proposal and contemporary theories of personality pathology, the Work Group has called for more research in this area (e.g., Bender, Morey, & Skodol, 2011). In response to this call, this study investigates the relationship between two major, well-validated dimensional measures of levels of personality functioning, that is, the Differentiation-Relatedness Scale (DR-S; Diamond, Blatt, Stayner, & Kaslow, 1991), as scored on the Object Relations Inventory (ORI; Blatt, Wein, Chevron, & Quinlan, 1979), and the Inventory of Personality Organization (IPO; Lenzenweger, Clarkin, Kernberg, & Foelsch, 2001), a self-report instrument, and their relationship with different measures of clinical and interpersonal functioning in 70 patients with a PD. First, results showed that higher levels of differentiation and relatedness of descriptions of self and significant others, and of the self in particular, were negatively related to indices of personality functioning as assessed by the IPO. Lower levels of personality functioning, as measured with both the DR-S and the IPO, were positively related to severity of depression, symptomatic distress, self-harm, and interpersonal problems. Finally, results showed that the DR-S and the IPO independently predicted clinical features and interpersonal functioning. Hence, this study lends further support for the concurrent and predictive validity of the DR-S and the IPO in assessing levels of personality functioning. However, more research concerning the validity of these measures in assessing levels of personality functioning is needed. Suggestions for further research are formulated.

Patterns of inner change and their relation with patient characteristics and outcome in a psychoanalytic hospitalization‐based treatment for personality disordered patients

This study investigated whether different clusters of patients with personality disorders in a psychoanalytic hospitalization-based treatment were associated with: (a) different changes in personality organization (PO); (b) different pre-treatment variables; and (c) different associations between changes in PO and outcome. K-means clustering analysis identified two clusters of patients, which showed different changes in PO and mainly differed in terms of levels of anaclitic and introjective personality features, respectively. Both clusters showed a significant decrease in symptoms and an improvement in personality functioning during treatment and at 3-month follow-up. Clinical implications of these findings are discussed.

Can we identify the factors influencing the burden on family members of patients with schizophrenia

A growing number of studies reflects an increasing growing interest in the burden on the family (BF) of sufferers from schizophrenia. Many of these studies aim at revealing and identifying the variables that determine BF. This review compares and discusses the results of these studies. Although many variables, such as the diagnosis and symptoms of the patient, the duration of the illness, the treatment setting (outpatient/inpatient), the family relationship between the patient and the relative, and the type of family intervention (counselling and psycho-education) are examined in various studies, there is little consensus on which factors determine the extent and/or pattern of BF. In our opinion, this lack of consistency is mainly caused by: (1) the varieties of definitions and operationalizations of BF employed; (2) the fact that most studies examine only one or just a few variables, so that variables other than those examined may have varied between studies; and (3) the difference in the periods of time...A growing number of studies reflects an increasing growing interest in the burden on the family (BF) of sufferers from schizophrenia. Many of these studies aim at revealing and identifying the variables that determine BF. This review compares and discusses the results of these studies. Although many variables, such as the diagnosis and symptoms of the patient, the duration of the illness, the treatment setting (outpatient/inpatient), the family relationship between the patient and the relative, and the type of family intervention (counselling and psycho-education) are examined in various studies, there is little consensus on which factors determine the extent and/or pattern of BF. In our opinion, this lack of consistency is mainly caused by: (1) the varieties of definitions and operationalizations of BF employed; (2) the fact that most studies examine only one or just a few variables, so that variables other than those examined may have varied between studies; and (3) the difference in the periods of time discussed in the different studies. To gain more insight into the factors that determine BF, a better standardization of the definition and operationalization of BF, as well as of the period of time studied, is needed, as well as exhaustive studies examining the various factors that may determine BF.

What's in a face? Mentalizing in borderline personality disorder based on dynamically changing facial expressions

The mentalization-based approach to borderline personality disorder (BPD) argues that impairments in mentalizing are a key feature of BPD. Most previous research in this area has concentrated on potential impairments in facial emotion recognition in BPD patients. However, these studies have yielded inconsistent results, which may be attributable to methodological differences. This study aimed to address several limitations of previous studies by investigating different parameters involved in emotion recognition in BPD patients using a novel, 2-step dynamically changing facial expression paradigm, taking into account the possible influence of mood, psychotropic medication, and trauma exposure. Twenty-two BPD patients and 22 matched normal controls completed this paradigm. Parameters assessed were accuracy of emotion recognition, reaction time (RT), and level of confidence, both for first and full response and for correct and incorrect responses. Results showed (a) that BPD patients were as accurate in their first, but less accurate in their full emotion recognition than normal controls, (b) a trend for BPD patients to respond more slowly than normal controls, and (c) no significant difference in overall level of confidence between BPD patients and normal controls. Mood and psychotropic medication did not influence these results. Exposure to trauma in BPD patients, however, was negatively related to accuracy at full expression. Although further research is needed, results suggest no general emotion-recognition deficit in BPD patients using a dynamic changing facial recognition paradigm, except for a subgroup of BPD patients with marked trauma who become less accurate when they have to rely more on controlled, reflective processes.