The Relationship between Affect Integration and Psychopathology in Patients with Personality Disorder: A Cross-Sectional Study

Abstract

Background and Objectives: Emotional dysfunction is considered a key component in personality disorders; however, only few studies have examined the relationship between the two. In this study, emotional dysfunction was operationalized through the Affect Integration Inventory, and the aim was to examine the relationships between the level of affect integration and the levels of symptom distress, interpersonal problems, and personality functioning in patients diagnosed with personality disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Materials and Methods: Within a hospital-based psychiatric outpatient setting, 87 patients with personality disorder referred for treatment were identified for assessment with the Affect Integration Inventory and other measures (e.g., the Symptom Checklist-90, Revised, the Inventory of Interpersonal Problems 64 circumplex version, and the Severity Indices of Personality Problems). Results: The analyses revealed that problems with affect integration were strongly and statistically significantly correlated with high levels of symptom distress, interpersonal problems, and maladaptive personality functioning. Additionally, low scores on the Affect Integration Inventory regarding discrete affects were associated with distinct and differentiated patterns of interpersonal problems. Conclusion: Taken together, emotional dysfunction, as measured by the Affect Integration Inventory, appeared to be a central component of the pathological self-organization associated with personality disorder. These findings have several implications for the understanding and psychotherapeutic treatment of personality pathology. Furthermore, they highlight the importance of considering the integration of discrete affects and their specific contributions in the conceptualization and treatment of emotional dysfunction in patients with personality disorders.

Emotional dysfunction in avoidant personality disorder and borderline personality disorder: A cross‐sectional comparative study

“…( 2009 ) established that levels of psychosocial dysfunction in terms of functional impairment and subjective distress associated with APD are comparable to the levels detected in BPD. In this study, our focus was beyond symptoms and general functioning, and we report data suggesting that APD and BPD have comparable levels of impairment in the structural capacity for perceiving, tolerating and comprehending affective reactions (Frederiksen et al ., 2021b ). Regarding the capacity to adaptively communicate affective states, the two groups differed slightly more with a lower mean score in the APD group.…”

“…In our view, emotional dysfunction as operationalized in the present study may effectively account for both general (e.g., Global AI) and specific aspects (e.g., Access to Interest) of BPD and APD. We also believe that our findings are particularly relevant to the upcoming ICD‐11 classification of PD severity (e.g., Bach & First, 2018 ; World Health Organization, 2018 ), which specifically relies on “Range and appropriateness of emotional experience and expression”, “Tendency to be emotionally over‐ or underreactive”, and “Ability to recognize and acknowledge unwanted emotions (e.g., anger, sadness).” The concept of AI appears to operationalize and assess all of these aspects of emotional dysfunction in a reliable and valid way (Frederiksen et al ., 2021a , 2021b ).…”

“…Data used in this cross‐sectional study constitute part of an overarching study of various aspects of AI in PDs (Frederiksen et al ., 2021a , 2021b ).…”

Driven or lacking access: Integration types as a subdimension of the affect consciousness construct

“…A semi-structured interview (the Affect Consciousness Interview; ACI) and separate rating scales (the Affect Consciousness Scales; ACSs) were developed to assess these aspects of affect integration and systematically tested in several studies (e.g., Monsen et al, 1996 ; Solbakken et al, 2011a ). A specific AC treatment model (ACT) was developed and tested (e.g., Monsen et al, 1995 ; Monsen and Monsen, 2000 ) and later a self-report instrument for more time-efficient assessment of AC, i.e., the Affect Integration Inventory (AII; Solbakken and Monsen, 2013 ) was constructed and tested in several studies (e.g., Solbakken et al, 2017 ; Frederiksen et al, 2021a , b , 2022 ). As mentioned, AC can formally be differentiated from affect integration as the operationalized measurement of the latter.…”

“…Unfortunately, research on individual differences in affective processes rarely differentiates between affects. The studies that have been conducted, however, show that differentiating between affects yields more informative findings, and report this approach as an advantageous focus for future research ( Rivers et al, 2007 ; Holmqvist, 2008 ; Monsen et al, 2008 ; Augustine and Hemenover, 2009 ; Webb et al, 2012 ; Johansen et al, 2013 ; Solbakken et al, 2017 ; Vishkin et al, 2019 ; Fiskum et al, 2021 ; Frederiksen et al, 2021a ; Solbakken and Monsen, 2021 ). As such, the explicit focus on discrete affects in the AC model makes integration types a concept we believe is better suited to access the nuances of affective processes than other related but undifferentiated concepts.…”