Quality of depressive experiences in borderline personality disorders: differences between patients with borderline personality disorder and patients with higher levels of personality organization

Clinical observations suggest that depressive experiences in patients with borderline personality disorder have a specific quality. These experiences are characterized by emptiness and anger ("angry depression") and are associated with primitive forms of object relations. In this study, this observation was tested empirically. A sample of borderline inpatients (N=30) was compared with a sample of inpatients with higher levels of personality organization suffering from neurotic disorders (N=30). Depression and other affects were assessed by the Affective Dictionary Ulm (Dahl, H?lzer, & Berry, 1992). The quality of object relations was assessed by a scale developed by Urist (1977), which was applied to responses in the Holtzman Inkblot Technique (Holtzman, Thorpe, Swartz, & Herron, 1961). Correlations were assessed between depression, on the one hand, and anger, anxiety, and the quality of object relations, on the other hand. The clinical observations were confirmed: In the patients with borderline personality disorder, depression showed significant correlations with the affects of anger, anxiety, and fear, and with primitive forms of object relations. In the patients with higher levels of personality organization, no such correlations were found. The results are discussed with regard to the understanding of borderline disorders, diagnosis, and therapy.     

Are alexithymia, depression, and anxiety distinct constructs in affective disorders?

OBJECTIVE: the present study was undertaken to gain a better insight into the relationship between alexithymia, anxiety, and depression. Two hypotheses were tested: (1) whether a depressive or anxiety disorder is associated with an elevation of one or more dimensions of alexithymia; and (2) whether alexithymia is an independent construct from depression and anxiety in patients with depressive or anxiety disorders. METHOD: a total of 113 patients with depressive or anxiety disorders (DSM-IV) and 113 control subjects completed the 20-item version of the Toronto alexithymia scale (TAS-20) and the hospital anxiety and depression scale (HADS). RESULTS: the TAS-20 total score was higher in depressed and anxious patients than in controls. This finding mainly depended on an increased score for "difficulty identifying feelings"(DIF), and (only in depressed patients) on an increased score for "difficulty communicating feelings" (DCF). The factor analysis of the TAS-20 and HADS items showed that depression is a construct different from alexithymia, whereas some overlap exists between anxiety and DIF dimension. CONCLUSION: our results suggest that in depressive and anxiety disorders, alexithymia and depression are separate constructs that may be closely related; in contrast, there are some overlaps between the DIF dimension and anxiety.     

A report on three patients with "rapid cycling" unipolar depression.

We report three cases of unipolar depression who meet criteria for "rapid cycling" by having four or more major depressive episodes within a 1-year period. This report describes the clinical characteristics of the three patients and discusses the concept of false unipolar depression, and compares these patients with the "pseudounipolar" group described by Akiskal et al. Our findings support the clinical notion that rapid cycling in unipolar depression is a rarity.     

The depressive character.

The depressive character is characterized by perpetual and unsuccessful efforts to maintain self-esteem and to avoid a sense of helplessness. Such individuals suffer from chronic depression which may or may not be masked, but which permeates their character. Although the condition is among the commonest seen in many of our clinics and practices, it remains without a generally accepted diagnostic form. It is suggested that the essential, clinical, dynamic, and structural features of the depressive character are: (1) consistently low self-esteem and a sense of helplessness, dependent object relations and chronic guilt; (2) self-directed aggression and masochism are frequent but not invariable; (3) extensive use of the mechanism of denial is as common as the previously described obsessional defenses seen in patients subject to psychotic depression; (4) often the depressive character suffers from intense oral envy; (5) depressive character traits may help to ward off any of the basic anxieties, namely, object loss, loss of love, castration anxiety, and superego anxiety (guilt) (6) the depressive character may be similar to a number of related disorders, namely, the obsessional character, hysterical characters with a large oral component, and depressive borderline states; (7) sensitivity to loss, sadness, and fragility of self-esteem makes the depressive character especially vulnerable to regression into overt depression; (8) the persistence of oral incorporative mechanisms, ambivalent, dependent object relations, ego versus superego tension with depressive affect, and sensitivity to loss are characteristic of the ego of the depressive character.     

Depression viewed as a state of disturbed psychic contact

The nature of disturbed object relations in depression is analyzed. The concept, area of interest, is introduced to describe the disturbed interplay between the depressive subject and the external world. Loss of psychic contact with the environment is considered the central feature in depression. Various psychological symptoms in depression, such as decline in self-esteem, feelings of guilt, self-reproach, hopelessness, and helplessness, are arranged in an understandable sequence beginning with loss of psychic contact. The paper discusses a model of depression, in which the loss of psychic contact with the external world is considered the stimulus for physiological symptoms such as early morning wakening, diurnal variation, and weight loss. The depressive episode may be viewed primarily as a state of disturbed psychic contact rather than as a state of disturbed affect.     

Self concept and parental images in patients with affective disorders--a clinical study with the Giessen Test

The relationship between self, ideal self and normative self was studied in a sample of 139 patients with affective disorders and 73 patients with orthopaedic complaints. The depressive patients showed significant-asymmetric relationships between self and ideal self even after recovery from the clinical depression. Neurotic depressive patients could be distinguished from unipolar depressive patients in this regard. The self-concept of the depressive patients was characterised by means of the bipolar Giessen-test dimensions "insufficiency of performance", "lack of social adjustment" and "lack of social contact" and by means of the GT-dimensions "negative social resonance" and "depressive mood". There were no specific relationships between self-image and parental images in the depressive sample. The results underline the necessity of therapeutic interventions in depressive patients during the so-called symptom-free interval.     

Is major depressive disorder in adolescence a distinct diagnostic entity?

The concept of major depressive disorder in childhood and adolescence is reviewed and it is suggested that contemporary enthusiasm for this diagnosis may have outrun the evidence that it is a distinct categorical entity. To test the hypothesis that major depression is not a qualitatively distinct disorder in adolescence, but rather a continuously distributed, noncategorical syndrome, the behavioral rating scales (CBCL-P) of 216 hospitalized adolescent patients were analyzed first by principal components analysis and then by cluster analysis. Three behavioral syndromes were isolated by principal components analysis. Of three groups of patients identified by a subsequent cluster analysis, one was consistent with the concept of a categorically distinct "nuclear" depression. However, a noncategorical continuously distributed depressive syndrome appears to affect a larger number of patients in this age group, and the "nuclear" disorder may be less prevalent than is currently assumed. One explanation of these findings would combine a categorical model of nuclear depression with a dimensional model of dysthymia.     

Validity of the depressive dimension extracted from principal component analysis of the PANSS in drug-free patients with schizophrenia

Depressive symptoms frequently occur during the course of schizophrenia. This study explored the relationships between the schizophrenia symptomatology and three measures of depression. Eighty-one drug-free inpatients with acute schizophrenia were assessed with the positive and negative syndrome scale (PANSS), the Calgary depression scale for schizophrenia (CDSS), and the Hamilton rating scale for depression (HAM-D). The depressive subscale of PANSS (PANSS-D) was also considered as a third scale for measuring depression. A principal component analysis (PCA) of PANSS items identified five clinical dimensions of schizophrenia called 'negative', 'positive', 'anxio-depressive', 'excitement', and 'disorganisation and others'. Our anxio-depressive dimension (PANSS-ad) was strictly identical with the PANSS-D. Scores on CDSS and HAM-D were highly inter-correlated and highly correlated with the PANSS-ad. Furthermore, while scores on CDSS were correlated only with this dimension, scores at HAM-D were also positively correlated with the negative dimension and negatively correlated with the excitement dimension. In conclusion, our results suggest that PANSS evaluation itself may be sufficient to give a correct approximation of the depression in patients with schizophrenia. However, depression scales are of course needed to assess specifically depressive symptoms in patients with schizophrenia; hence, the CDSS could be a more specific instrument than HAM-D.     

High somatic distress with high long-term stability in selected patients with chronic depression: a 3-year follow-up of ratings with Karolinska Scales of Personality (KSP)

The main aim of the present study was to investigate mean levels and long-term stability of three scales from the Karolinska Scales of Personality (KSP), assessing somatic components of anxiety proneness in selected patients with chronic depressive symptoms. The KSP was filled in by 84 patients (26 men and 58 women) with a history of or ongoing major depression and audiological, or other comorbid somatic, symptoms. Mean scores for the Somatic Anxiety, Muscular Tension and Psychasthenia scales were above two standard deviations compared to a normative group sampled from the population. The KSP was filled in at follow-up by 65 patients. The mean interval between the ratings was 3.5 years. Comparisons between the ratings of the three scales revealed no significant mean score differences, and quite high individual stability. The mean scores were significantly increased in comparisons with depressed patients in primary care suggesting that these patients with chronic depression may comprise a depressive sub-type characterized by high "somatic distress". A putative origin for the high and stable scores in the presented sub-group of depressed patients, and the concept of "personality trait" in use even for pronounced symptoms, are discussed.     

Do spirituality and religiousness differ with regard to personality and recovery from depression? A follow-up study

BackgroundThe studies show that both spirituality and religiousness are protective for mental health. Personality is related with course and outcome of depression, as well as spirituality and religiousness, and their relations toward to recovery from depression are underresearched. This study followed influence of spirituality and religiousness on course and outcome of depression in patients with depressive episode, controlled for personality dimensions.MethodsThe patients were assessed with self-report measures of depression (Beck Depression Inventory), spirituality (WHO-Quality of Life-Spiritual, Religious, Personal Beliefs), religiousness (Duke University Religion Index) and personality (Temperament and Character Inventory). Ninety nine patients finished a year long follow up.ResultsHigher spirituality influenced recovery of depression in patients with depressive episode, but religiousness did not show to be significant predictor of recovery for depression. Dimension harm avoidance was significant predictor of improvement of depression in all points of measurement.LimitationsSome limitations of this research are small sample size, usage of the self-report measures of depression in follow-up period, and the predominantly Catholic affiliation of the participants that can impact the generalizability of our data to other denominations.ConclusionSpirituality and dimension harm avoidance are significant predictors of recovery from depression during a year long follow up.     

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Defensive Functioning Scale: a validity study

Objective

We assess the convergent and predictive validity of the Defensive Functioning Scale (DFS) with measures of life events, including childhood abuse and adult partner victimization; dimensions of psychopathology, including axis I (depressive) and axis II (borderline personality disorder) symptoms; and quality of object relations.

Method

One hundred and ten women from a university-based urban primary care clinic completed a research interview from which defense mechanisms were assessed. The quality of object relations was also assessed from interview data. The women completed self-report measures assessing depression, borderline personality disorder symptoms, childhood physical and sexual abuse, and adult partner physical and sexual victimization.

Results

Inter-rater reliability of the scoring of the DFS levels was good. High adaptive defenses were positively correlated with the quality of object relations and pathological defenses were positively correlated with childhood and adult victimization and symptom measures. Although major image distorting defenses were infrequently used, they were robustly correlated with all study variables. In a stepwise multiple regression analysis, major image distorting defenses, depressive symptoms, and minor image distorting defenses significantly predict childhood victimization, accounting for 37% of the variance. In a second stepwise multiple regression analysis, borderline personality disorder symptoms and disavowal defenses combined to significantly predict adult victimization, accounting for 16% of the variance.

Conclusions

The DFS demonstrates good convergent validity with axis I and axis II symptoms, as well as with measures of childhood and adult victimization and object relations. The DFS levels add nonredundant information to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition beyond axis I and axis II.     

A developmental perspective of depression--towards a novel formulation

A novel conceptualization of depression, analyzed in a developmental frame of reference, is based on three major postulates: 1) the distinction between an anaclitic type of depression, triggered by the traumatic loss of a need-satisfying object, and depression of a reflexive (narcissistic) type, caused by the loss of a recognizing/mirroring object; 2) in principle, anaclitic object loss involves reflexive implications and vice versa; 3) very early breaks of object relationships, at the first symbiotic stage of life, are pre-narcissistic by nature. These three assumptions form the basis for a systematic juxtaposition of two developmental lines--one line from first-stage symbiosis to anaclitic object relations, and the second line--from second-stage symbiosis to reflexive object relations. Even though the two lines are closely intertwined, corresponding distinct forms of depressive reactions can be discerned in each line, according to the type of the lost object relationship.     

Self-other representations mediate the relationship between Five-Factor Model depression and depressive states

While it is well established that trait depression is a risk factor for experiencing increased rates of episodes of depression, it is also the case that the ways in which the self and others are perceived, and nature of the relationship between self and other, predispose individuals to frequent depressive episodes. In this study, 182 psychiatric outpatients at three treatment facilities were evaluated for Five-Factor Model depressive traits, depressive states, and self-other representations (object relations). It was hypothesized that object relations would mediate the relationship between trait and state depression. Results partially confirmed this hypothesis. While trait depression significantly predicted variance in the Beck Depression Inventory-II (BDI-II; Beck et al., 1988), two dimensions of the Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, 1995)--Alienation and Insecure Attachment--partially mediated the relationship between trait and state depression. Similarly, trait depression predicted tendencies to experience frequent shifts toward depressive episodes, although the Insecure Attachment and Egocentricity scales of the BORRTI fully mediated the relationship between trait depression and depressive lability. Knowledge of self-other representations, which is being considered for inclusion in the DSM-5, allows for a more refined understanding of those factors that contribute shifts in depressive mood.     

单、双相抑郁障碍血清细胞因子水平的比较研究

目的　探讨细胞因子在单、双相抑郁障碍发病中的作用。方法　采用酶联免疫吸附法(ELSIA)检测 35例单相抑郁、2 3例双相抑郁和 30名健康对照的血清IL 2、sIL 2R、IL 10、IL 12水平。结果　单相组血清IL 2明显低于对照组和双相组 (P <0 0 5 ) ;血清IL 2水平降低与抑郁症的病程和严重程度无相关性 (P >0 0 5 )。结论　单相抑郁和双相抑郁间可能存在着不同的免疫学机制 ,在单相抑郁中存在免疫激活现象 ,IL 2可能起一定的作用     

Multidimensionality and state dependency of alexithymia in recently sober alcoholics

In this study, we a) examined the appropriateness of using a single global score to represent alexithymia and b) constructed a model to examine the relationship between alexithymia and depression in recently sober alcoholics applying for inpatient care. To measure alexithymia, we used the Toronto Alexithymia Scale (TAS); to measure depression, we used the revised Beck Depression Inventory (BDI). Factor analyses identified three alexithymia factors (Feelings, Daydreaming, and External Thinking) and two depression factors (Somatic-Performance and Cognitive-Affective). The three TAS factors were not positively related to each other; the two BDI factors were. We used LISREL software to examine the relationships between the TAS factors and the BDI factors. The only two significant unidirectional coefficients were between the TAS-Feelings factor and the two BDI factors. Our results suggest that in recently sober alcoholics, alexithymia, as measured by the TAS, consists of three independent, unrelated dimensions. Moreover, only the dimension associated with an inability to identify feelings and to distinguish them from bodily sensations is related to depressive symptoms. To determine whether this alexithymia feelings dimension actually is dependent on situational depression and/or anxiety will require confirmation in additional samples, such as primary alexithymics and patients with major depressive disorders.     

Depression influences the EDI scores in anorexia nervosa patients.

AIM: To study the influence of the severity of depression on the eating disorder's inventory (EDI) scores in anorexia nervosa (AN) patients. METHOD: We compared by variance analysis the EDI scores from three groups of AN patients: 55 patients having a major depression (as assessed by a Beck's depression inventory (BDI) >/= 16); 77 patients having a less severe depression (BDI < 16); 32 patients with mild or non-existent depression (BDI 相似文献   

Male depression in a population sample of young males. Risk and symptom profiles

The concept of male depression basically assumes that the well-known depressive symptoms in males are compensated for or masked by external behavioral patterns, which are atypical for depression and therefore not included in conventional depression inventories. In a community sample of young males (n=1,004) the general well-being and risk of male depression were investigated using the WHO-5 Well-Being Scale and the Gotland Scale for Male Depression. The main questions focused on the analysis of symptoms dependent on the risk of male depression. Hypotheses were related to depressive symptoms being masked by distress symptoms, to the dimensionality of the Gotland Scale, to different symptom clusters and to the contribution of isolated symptoms to the risk of depression. The results demonstrated a reduced well-being and a risk of male depression in 22% of the respondents. The data gave no evidence to support the hypothesis that depressive symptoms are masked by distress symptoms or for latent depression and stress components. However, a "depression cluster" and a "distress cluster" could be differentiated by cluster analyses giving indications of the clinical relevance of the male distress symptoms for the development of depression. The more severe these are, the higher is the risk of male depression. Finally, the results are discussed in the face of the limitations of the study, the previous evidence and open questions.     

Some Theoretical and Practical Implications of a Longitudinal Study of College Woment†

Abstract

While it is well established that trait depression is a risk factor for experiencing increased rates of episodes of depression, it is also the case that the ways in which the self and others are perceived, and nature of the relationship between self and other, predispose individuals to frequent depressive episodes. In this study, 182 psychiatric outpatients at three treatment facilities were evaluated for Five-Factor Model depressive traits, depressive states, and self-other representations (object relations). It was hypothesized that object relations would mediate the relationship between trait and state depression. Results partially confirmed this hypothesis. While trait depression significantly predicted variance in the Beck Depression Inventory-II (BDI-II; Beck et al., 1988), two dimensions of the Bell Object Relations and Reality Testing Inventory (BORRTI; Bell, 1995)—Alienation and Insecure Attachment—partially mediated the relationship between trait and state depression. Similarly, trait depression predicted tendencies to experience frequent shifts toward depressive episodes, although the Insecure Attachment and Egocentricity scales of the BORRTI fully mediated the relationship between trait depression and depressive lability. Knowledge of self-other representations, which is being considered for inclusion in the DSM-5, allows for a more refined understanding of those factors that contribute shifts in depressive mood.     

Sensation seeking and mood dimensions in depressive states]

This study presents the investigation of the relations between dimensions of depressive mood and sensations seeking in 55 hospitalized depressed subjects. The concept of sensation seeking, identified by M. Zuckerman as a personality dimension, has been defined as the need for the subject to reach his optimal level of activation. The four subscores of sensation seeking, relatively independent, are identified in the sensation seeking scale; they stand at different levels on the dimensions of activation and pleasure which are emotional dimensions. These emotional dimensions are investigated in the exploration of the emotional components of depressive mood; the different symptomatic regroupings, such as blunted affect or impulsivity, do not have the same relations with these dimensions. The sensation seeking concept appears fruitful to investigate the different troubles of affective dynamic, which stand on the expressive and behavioral level, and on the subjective level. As in several studies with normal populations, we find again the same inverse relation between age and sensation seeking, and men obtain higher scores on the Thrill and Adventure seeking factor and on the Desinhibition factor. Globally, depressed subjects have lower scores of sensation seeking than normal subjects (paired by age and sex); but the weakness of sensation seeking is not proportional to the intensity of depression (Hamilton Depressive Scale) and to the the intensity of anxiety (Covi Brief Anxiety Scale). Interesting relations appear with the depressive mood factors, which agree with previous studies of sensation seeking in psychology and psychopathology.(ABSTRACT TRUNCATED AT 250 WORDS)     

Expression of depressive symptoms in a nonclinical Brazilian adolescent sample.

OBJECTIVE: This study aimed to detect the prevalence of depressive symptomatology and its expression in a nonclinical Brazilian adolescent student sample. METHOD: A sample of students from private and public schools (n = 1555, aged 13 to 17 years) answered the Beck Depression Inventory (BDI). We performed factor analysis of the BDI as an indicator of the expression of depressive symptomatology. The following cut-off scores defined nonclinical subgroups: "nondepressed," BDI < 15; "dysphoria," BDI 16 to 20; and "depressed," BDI > 20. We used discriminant analysis to test whether these subgroups could be separated by the depression-specific and nonspecific items. RESULTS: The point prevalence of depression was 7.6%, according to the BDI cut-off of 20. Girls had higher scores than boys in several items. Scores increased with age. Students from public schools had higher scores than did private school students. Factor analysis showed 2 common factors for the total sample and for each sex: the cognitive affective dimension and the somatic nonspecific dimension. In the adolescents showing clinical depression, items related to self-depreciation, sense of failure, guilty feelings, self-dislike, suicidal wishes, and distortion of body image were common components of BDI factors. Discriminant analysis showed that the BDI highly discriminates depressive symptomatology in adolescent students and also measures specific aspects of depression. CONCLUSIONS: The BDI is useful as a measure of specific aspects of depression in nonclinical adolescent samples; it was able to detect depression in approximately 7% of the surveyed population. The expression of depressive symptoms in a Brazilian adolescent population is compatible with international studies in this age group. Detecting depressive symptoms in a school population is a critical preventive strategy; to avoid damage to the learning process, it should be followed with further referral to treatment when needed.