A key ingredient in the current proposal of the DSM-5 Work Group on Personality and Personality Disorders is the assessment of overall severity of impairment in personality functioning: the Levels of Personality Functioning Scale (LPFS). The aim of this article is to contribute a conceptual and empirical discussion of the LPFS from the perspective of the Operationalized Psychodynamic Diagnosis (OPD) system (OPD Task Force, 2008 ). First, we introduce the OPD Levels of Structural Integration Axis (OPD-LSIA), a measure of individual differences in severity of personality dysfunction that is rooted in psychodynamic theory. We show that the OPD-LSIA is reliable, valid, and highly associated with observer ratings of personality disorders. In the second part, we present results from an OPD expert consensus study exploring potential limitations of the current LPFS item set from the perspective of the OPD-LSIA. We conclude with highlighting implications for future revisions of the DSM-5 proposal.

The concept of psychic structure plays a central role in the Operationalised Psychodynamic Diagnosis (OPD) system. Until recently, its reliable and valid assessment had to be based on expert ratings of clinical interviews, limiting the use of the OPD in routine measurements and research, and excluding the patients' perspective. The current study describes the development and evaluation of a questionnaire on the OPD structure axis (OPD-SQ) in several clinical and non-clinical samples (N = 1 112). The questionnaire demonstrated good internal consistency for all the sub-scales of the OPD-SQ. Differences in mean values between the samples and between patients with vs. without personality disorders were as expected. We also found correlations with other relevant aspects of personality (attachment security, neuroticism). There were no to minimal effect of age and gender. The OPD-SQ is a helpful tool for a broad use in clinical routine as well as research projects.

The "Experiences in Close Relationships--Revised" (ECR-R) is a well developed instrument for assessing attachment in adults, which is used in different research areas around the world. In this paper the German version (ECR-RD) was evaluated in a large non-clinical (N = 1006) and a clinical sample (N = 225). Overall, the good psychometrical properties were confirmed (Cronbach's alpha = 0,91/0,92), we also found evidence for construct validity. There was a substantial difference between the two samples in the ECR-RD as well as a specific impact of comorbid personality disorders. The ECR-RD can be seen as a reliable, internationally comparable instrument for assessing romantic attachment representations that can be used in clinical samples.

Maternal depression poses a risk for the developing mother-infant relationship. Similarly, maternal insecure attachment styles may limit the ability to adequately connect with the newborn during the postpartum period. The aim of this study was to investigate the effect of maternal depression and insecure attachment (insecure and dual/disorganized) on maternal bonding in a sample of n = 34 women with depression according to DSM-IV and n = 59 healthy women. Maternal depression was assessed 3 to 4 months postpartum with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), bonding with the Postpartum Bonding Questionnaire, and maternal attachment style with the Attachment Style Interview. Women with current and lifetime depression as well as women with dual/disorganized attachment style reported lower bonding. Explorative analysis revealed that depression partially mediated the link between dual/disorganized attachment style and bonding with a medium-sized mediation effect. The combination of maternal depression and dual/disorganized attachment style may pose a special risk constellation for the developing mother-infant bond that should be addressed in prevention and early intervention programs.

The findings support the importance of insight for psychotherapy outcome. Insight may be a relevant mechanism of change across different treatment modalities.

Summary Development of a 12-item version of the OPD-Structure Questionnaire (OPD-SQS)Objectives: Screening for personality dysfunction is relevant to treatment planning in psychotherapy, psychosomatic medicine and psychiatry. This makes short versions of field-tested approaches such as the OPD Structure Questionnaire (OPD-SQ) necessary. Methods: With the aim of developing a screening version, the original sample of the OPD-SQ was divided into two subsamples. After developing a preliminary 12-item version in one subsample, we used confirmatory factor-analysis in the second subsample as well as an independent sample to test the factor structure. Results: The analyses confirmed a structure of three correlating factors with adequate fit indices. Other findings relating to the validity of the long version were replicated as well. In addition, data from an independent sample of psychotherapy inpatients confirmed the factor structure and provided further evidence for its validity. Conclusions:The OPD-SQS is a viable screening instrument for supporting clinical decision making in stepped-care approaches in psychotherapy, psychosomatic medicine and psychiatry.

The psychoanalytically informed construct of 'defence mechanisms' is of central importance for the understanding of the dynamics of inner conflicts and the onset of neurotic symptoms. Objective and valid assessment of 'defence' is difficult. There are a number of observer rating instruments but only few self-report questionnaires. The German version of the 'Defence Style Questionnaire - DSQ 40' (Andrews, Singh, & Bond, 1993) was examined with regard to its factorial and content validity, and its sensitivity to change during inpatient psychotherapy. One hundred and fifty-five patients with mixed diagnoses were administered the DSQ 40 and the SCL-90-R before and after 3 months of inpatient psychotherapy. Diagnoses were mostly affective and anxiety disorders as well as eating disorders, and there was a high comorbidity of personality disorders. After deletion of some items due to insufficient pairwise item-intercorrelation or false classification to a defence mechanism by experienced clinicians, we found three stable factors of defence (maladaptive, intermediate-neurotic and adaptive) consistent with the previous research. After 3 months of therapy, a decrease in maladaptive mechanisms and an increase in adaptive patterns were found, while neurotic mechanisms did not change on average. Our shortened version of the DSQ 40 was shown to be a valid instrument for the assessment of defence mechanisms and change in these mechanisms after psychotherapy. Our design did not permit an assessment of whether or not the change in defence mechanisms was due to the therapeutic treatment.

Our results provide further evidence for altered cardiovascular reactivity and impaired cardiac autonomic functioning in depression. Further research is needed on psychophysiological response to either more disease-oriented or more personality-oriented stressors.