Clinicians’ emotional responses and Psychodynamic Diagnostic Manual adult personality disorders: A clinically relevant empirical investigation.

Abstract

The aim of this study is to explore the relationship between level of personality organization and type of personality disorder as assessed with the categories in the Psychodynamic Diagnostic Manual (PDM; PDM Task Force, 2006) and the emotional responses of treating clinicians. We asked 148 Italian clinicians to assess 1 of their adult patients in treatment for personality disorders with the Psychodiagnostic Chart (PDC; Gordon & Bornstein, 2012) and the Personality Diagnostic Prototype (PDP; Gazzillo, Lingiardi, & Del Corno, 2012) and to complete the Therapist Response Questionnaire (TRQ; Betan, Heim, Zittel-Conklin, & Westen, 2005). The patients' level of overall personality pathology was positively associated with helpless and overwhelmed responses in clinicians and negatively associated with positive emotional responses. A parental and disengaged response was associated with the depressive, anxious, and dependent personality disorders; an exclusively parental response with the phobic personality disorder; and a parental and criticized response with narcissistic disorder. Dissociative disorder evoked a helpless and parental response in the treating clinicians whereas somatizing disorder elicited a disengaged reaction. An overwhelmed and disengaged response was associated with sadistic and masochistic personality disorders, with the latter also associated with a parental and hostile/criticized reaction; an exclusively overwhelmed response with psychopathic patients; and a helpless response with paranoid patients. Finally, patients with histrionic personality disorder evoked an overwhelmed and sexualized response in their clinicians whereas there was no specific emotional reaction associated with the schizoid and the obsessive-compulsive disorders. Clinical implications of these findings were discussed.

Determinants and Predictive Value of Clinician Assessment of Short‐Term Suicide Risk

“…In particular, clinicians' emotional responses to their patients, which may represent both the integration of experience (De Gelder, Morris, & Dolan, ; Meeren, van Heijnsbergen, & de Gelder, ) and factors biasing clinical judgment (Bermúdez, ; Garb, ), may be important contributors to their impression of suicide risk. Indeed, the psychodynamic literature has long recognized the value and utility of therapists' emotional reactions to their patients (Betan, Heim, Zittel Conklin, & Westen, ; Gazzillo et al., ; Pallagrosi, Fonzi, Picardi, & Biondi, ), particularly when those reactions are used to develop a deeper understanding of the patient (Hayes, ).…”

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

“…However, these studies did not use homogeneous or comparable methodologies, and they did not specifically investigate the potential diagnostic value of these feelings in psychiatric clinical settings. On the other hand, some psychodynamic authors have thoroughly investigated the correlation between personality disorders and therapist's feelings through standardized instruments, providing intriguing results [68,69,70,71,72] and making interpretative hypotheses [73]. Their studies, however, have only a limited overlap with ours, as they focused on psychotherapeutic settings and long-lasting clinical relationships rather than on the first contact with a patient, where issues of clinical assessment, intuition, and diagnosis are prominent.…”

“…In particular, we hypothesized that (1) on the difficulty in attunement scale, patients with schizophrenia would elicit higher scores than all other diagnostic groups, even patients experiencing a bipolar manic or mixed episode; (2) on the disconfirmation scale, patients with cluster B personality disorders would elicit higher scores than all other diagnostic groups, even patients with a bipolar manic or mixed episode, and (3) on all scales except engagement, patients with unipolar depression or anxiety disorders would elicit lower scores compared with all other diagnostic groups. The first two hypotheses were based on the common, though still relatively unexplored empirically, tenet that patients with schizophrenia and cluster B personality disorders elicit distinct and diagnostically useful reactions from clinicians, such as the ‘Praecox Gefühl' [41,42,44,58], and feelings of anger, unworthiness, and of being devalued and manipulated [68,69,70,72,75], respectively. The third hypothesis was based on the assumption that the help-seeking attitude usually seen in patients with depression and anxiety, together with the absence of psychotic symptoms, would favour the development of a traditional helping relationship with relatively low negative feelings, similar to the doctor-patient relationship commonly seen in other medical settings.…”

Personality Assessment in the Diagnostic Manuals: On Mindfulness, Multiple Methods, and Test Score Discontinuities

“…Because Axis M ratings capture strength and adaptation as well as dysfunction and deficit, the PDM is unique among the major diagnostic systems; the DSM-5 and ICD-10 both focus more or less exclusively on the identification of pathology. Although the PDM is less widely used than the DSM-5 or ICD-10, it has received increasing attention from researchers in recent years (see Etzi, 2014; Gazzillo et al, in press), and has been employed in clinical settings as an adjunct to the more widely used diagnostic systems, especially in Europe (Gazzillo, Lingiardi, & Del Corno, 2012). The PDM is currently being revised and updated, with PDM-2 scheduled for publication in 2015 (Lingiardi, McWilliams, Bornstein, Gazzillo, & Gordon, in press).…”