Dependent Personality and Interpersonal Dependency: At the Intersection of Developmental,Identity and Interpersonal Aspects

The author examines dependency as a pathological personality feature—one that originates in failures of developmental need fulfilment—and shows how the subsequent identity impairment may influence adult relationships. The author argues that, developmentally, the caregiver's unresolved pathological dependency causes a disruption in the child's need gratification as the child's focus is turned towards the caregiver's pathological needs. Internal object relations become characterized by a dependent internal object and need-fulfilling self-representation, which are supported developmentally by the disavowal of authentic dependency needs. In adult life, the individual's identity and self-esteem, through projections, become dependent on interpersonal relationships, which are used to control internal cohesion at the expense of authentic attachment and intimacy. Pathological dependency is thus intrapsychic rather than merely interpersonal. The author also explores the concept of excessive independence, that is, through identification with independence as an ego ideal, considered a defensive attempt to disidentify from an underlying pathological dependency.     

Evolution of Clinical Outcome Measures and Biomarkers in Sporadic Adult-Onset Degenerative Ataxia

Background

Sporadic adult-onset ataxias without known genetic or acquired cause are subdivided into multiple system atrophy of cerebellar type (MSA-C) and sporadic adult-onset ataxia of unknown etiology (SAOA).

Objectives

To study the differential evolution of both conditions including plasma neurofilament light chain (NfL) levels and magnetic resonance imaging (MRI) markers.

Methods

SPORTAX is a prospective registry of sporadic ataxia patients with an onset >40 years. Scale for the Assessment and Rating of Ataxia was the primary outcome measure. In subgroups, blood samples were taken and MRIs performed. Plasma NfL was measured via a single molecule assay. Regional brain volumes were automatically measured. To assess signal changes, we defined the pons and middle cerebellar peduncle abnormality score (PMAS). Using mixed-effects models, we analyzed changes on a time scale starting with ataxia onset.

Results

Of 404 patients without genetic diagnosis, 130 met criteria of probable MSA-C at baseline and 26 during follow-up suggesting clinical conversion to MSA-C. The remaining 248 were classified as SAOA. At baseline, NfL, cerebellar white matter (CWM) and pons volume, and PMAS separated MSA-C from SAOA. NfL decreased in MSA-C and did not change in SAOA. CWM and pons volume decreased faster, whereas PMAS increased faster in MSA-C. In MSA-C, pons volume had highest sensitivity to change, and PMAS was a predictor of faster progression. Fulfillment of possible MSA criteria, NfL and PMAS were risk factors, CWM and pons volume protective factors for conversion to MSA-C.

Conclusions

This study provides detailed information on differential evolution and prognostic relevance of biomarkers in MSA-C and SAOA. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.