Structural Personality Organization as Assessed With Theory Driven Profile Interpretation of the Dutch Short Form of the MMPI Predicts Dropout and Treatment Response in Brief Cognitive Behavioral Group Therapy for Axis I Disorders

Abstract

We investigated the validity of theory driven profile interpretation of the MMPI (Hathaway & McKinley, 1943) Dutch Short Form (DSFM; Eurelings-Bontekoe, Onnink, Williams, & Snellen, 2008) as a measure of personality organization (PO) in a naturalistic follow-up study among 576 psychiatric outpatients receiving brief cognitive behavioral group therapy. Results showed that this assessment method was useful in predicting dropout as well as treatment response. Patients with a latent psychotic PO profile and a manifest low-level borderline organization profile were 3 times more likely to drop out than patients with other PO profiles. Patients with a latent psychotic PO profile who continued treatment had deteriorated at 4-month follow-up. Patients with a manifest low-level borderline PO profile who remained in treatment, however, showed considerable therapeutic progress. We conclude that theory driven profile interpretation of the DSFM as an assessment of PO may be useful in predicting dropout and treatment response to cognitive behavioral treatment of Axis I disorders.

Do Patients with Somatoform Disorders Present with Illusory Mental Health?

“…This is in agreement with the notion that the introversion/extraversion dimension is a temperamental disposition influencing the type of personality disorder (internalizing versus externalizing) but not the severity of structural personality pathology [39]. For a more detailed description of the rationale behind the assessment method, and the interpretation of the several DSFM profiles see [34,35].…”

“…SFD-patients, compared to psychiatric controls, were characterized by a combination of a relatively high level of affect tone in relationships, comparable to that of normals, implying positive expectations of social relationships, and at the same time a lower level of emotional investment in relationships [48]. The low level of indirectly assessed emotional investment in SFD contrasts with the very low level of self-reported Self-centeredness among SFD-patients and suggest that patients with SFD are selfpreoccupied and have difficulties differentiating between the needs and desires of self and others [35] but may present with "eager to please"-characteristics, i.e. a strong need for self-confirmation by meeting the needs of others.…”

“…These groups are mutually exclusive. Several studies have provided evidence for the validity of the DSFM to capture features of PO [31,[34][35][36][37][38]. In the present study, internal consistency of the several subscales ranged from 0.69 (subscale Severe Psychopathology) to 0.90 (subscale Shyness).…”

“…The DSFM [33] assesses five personality dimensions: Negativism, Somatization, Shyness, Severe psychopathology, and Extraversion. As has been described elsewhere [31,[34][35][36][37][38], the theory-driven profile interpretation of scores on the DSFM is based on the notion that raw scores on the dimensions of the DSFM should be combined into profiles based on theoretical considerations concerning structural personality features and organization. These a priori defined profiles are subsequently interpreted by using Kernberg's tripartite model of personality pathology [29,30].…”

“…Within the theory driven profile approach, this subtype is defined on the basis of low scores on both Shyness and Severe Psychopathology because patients with narcissistic dynamics tend to deny vulnerabilities on selfreports [24], related to their inability to view themselves realistically [40] and to present with illusory mental health [5]. These patients often function well on the surface, especially in distant relationships, but they show "eager to please" characteristics [35]. Beneath this strong surface, there is identity diffusion, anger, and a sense of entitlement [37].…”