Between a rock and a hard place: Associations between Mentzos' “dilemma”, self‐reported interpersonal problems, and psychosocial functioning in individuals with non‐affective psychoses

Abstract

Primary aim of this study was to determine the extent and type of self‐reported interpersonal problems in patients with non‐affective psychoses and their impact on psychosocial functioning. Furthermore, we aimed to explore potential links with the psychodynamic construct of Stavros Mentzos' “psychotic dilemma”, which describes an insufferable inner tension caused by an individual's struggle of being torn between “self‐oriented” and “object‐oriented” tendencies. In a cross‐sectional study among 129 patients with non‐affective psychoses, measures of cognition, symptom load and social functioning as well as a tentative, psychodynamic assessment of Mentzos' “dilemma” were obtained during a clinical research visit. Self‐report data on interpersonal problems were gathered using the Inventory of Interpersonal Problems (IIP‐64D) and compared with a German representative standard sample. Second, IIP‐64D scores were compared between groups with or without Mentzos' “dilemma”. Hierarchical regression analyses were performed to test for the impact of interpersonal problems on psychosocial functioning, while controlling for cognitive deficits and psychopathology. Results showed that IIP‐64D scores differed significantly from healthy controls, except for “self‐centred” and “intrusive” interpersonal styles. Participants with a potential “psychotic dilemma” scored significantly higher on the subscales: “domineering”, “self‐centred”, “cold”, and “socially avoidant” than the group without a “psychotic dilemma”. The total amount of interpersonal problems, and particularly high scores on the IIP‐64D “socially avoidant” subscale, predicted psychosocial dysfunction, whereas a “cold” interpersonal style had an opposite effect. In conclusion, specific interpersonal problems may predict psychotherapeutic outcome measures like psychosocial functioning and are partly compatible with the psychodynamic construct of Stavros Mentzos' “psychotic dilemma”.

Level of structural integration in people with schizophrenia and schizoaffective disorders - applicability and associations with clinical parameters

“…Findings regarding Internal objects and External objects are in line with the results from the pilot study by Uzdawinis et al. ( 30 ), studies on the attachment style of people with psychosis ( 77 , 78 ) and psychoanalytic theories that consider schizophrenia as a relationship disorder, such as the concept of an irreconcilable dilemma between self- and other-directed tendencies ( 53 , 79 , 80 ). Difficulties in Object perception may correspond to the well-described deficits on theory of mind and social cognition in schizophrenia ( 81 ).…”

“…The study was approved by the ethics committee of the Charité Universitätsmedizin Berlin. Subsamples have already been published with other research questions ( 50 – 53 ). Participants were n = 74 male and n = 55 female outpatients meeting the DSM-IV-TR criteria of schizophrenia or schizoaffective disorder (Diagnostic and Statistical Manual of Mental Disorders; 54 ).…”

“…This led to the following hypotheses: 1a) There are significant negative correlations between structural abilities (OPD-2-LSIA) and severity of illness as well as psychotic symptom load. (50)(51)(52)(53). Participants were n = 74 male and n = 55 female outpatients meeting the DSM-IV-TR criteria of schizophrenia or schizoaffective disorder (Diagnostic and Statistical Manual of Mental Disorders; 54).…”

Measuring Emotional Awareness in Patients With Schizophrenia and Schizoaffective Disorders

“…The interview was conducted by two investigators from a pool of clinical psychologists trained in interview and rating principles. They asked questions about levels of social functioning and symptomatology but also encouraged the patients to talk freely about significant relationships or life events that were important to them in their past (see Bröcker et al, 2017 ; Stuke et al, 2020 for a detailed description). MAS-A-G and OPD-LSIA ratings are based on consensus rating of the respective investigators who conducted the interview.…”

Mentalizing in the context of Mentzos’ dilemma–on the use of implicit work in the treatment of non-affective psychosis

“…They might take all responsibility, give inappropriate personal information, or – on the other hand – become “too technical” and leave the patient to their own devices [for an overview see ( 17 , p. 92ff)]. Another manifestation of the dilemma (in countertransference) can be extreme subtlety or cautiousness or even a desire for fusion and symbiosis in the therapist ( 55 ). Sometimes therapists may experience unusual somatic reactions during sessions.…”