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Personality and object relations in patients with affective disorders: idiographic research by means of the repertory grid technique

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Abstract

Background: This paper presents an idiographic approach to evaluate the self concept and the self-object-relationship of patients suffering from affective disorders. Methods: Significant dimensions of the personality and the object relations of 127 depressive patients and 34 orthopaedic patients were investigated with the repertory grid-technique. The self concept and the object relations were compared by means of nomothetically used idiographic results after recovery from manifest depression. Results: ‘Low self esteem’ was frequently found in patients with a long lasting course of illness and the ICD-10-diagnoses of ‘bipolar affective disorder’ and ‘dysthymia’. The object relations of the depressive sample were characterised by the dimension ‘symbiotic near’; ‘ambivalent’ and ‘indifferent’ partnership relationships were found much more frequently in the controls. Conclusions: The idiographic results help to differentiate the spectrum of affective disorders. They underline the importance of the interpersonal dimension of depression and may be used as a basis of a therapeutic appraisal. Limitations: The repertory grid-technique may not be used as a diagnostic instrument. However, the combination of idiographic results with further clinical informations enables the multidimensional assessment of the self concept and psychosocial coping mechanisms.

Introduction

Studies of personality related dispositions in patients with affective disorders have a long clinical tradition (Kraepelin, 1913, Bleuler, 1922, Sjöbring, 1923, Tellenbach, 1961, Leonhard, 1963, Lauter, 1969, Zerssen, 1977, Hirschfeld and Cross, 1982, Akiskal, 1983, Akiskal et al., 1983, Blankenburg, 1986, Kisker et al., 1987, Möller and Zerssen, 1987, Peters, 1988, Möller, 1992). More recent studies underline the moderating function of the personality in the free interval (Kröber, 1988, Kröber, 1992, Kröber et al., 1998). Various research strategies were developed to answer the question which role interpersonal factors play in relation to etiology, prognosis, therapy and coping with depressive disorders (Halweg, 1991, Mundt, 1991, Corryell et al., 1993).

Some of the personality dimensions investigated by means of standardized personality inventories were only weakly related to the clinically relevant personality constructs (Möller and Zerssen, 1987) The results of factor analyses, cluster analyses and discriminant analyses showed multipolar group structures with permeable boundaries (Steck, 1988). Further relevant dimensions which were neglected until now, can be presumed. Therefore an idiographic approach was chosen (Repertory Grid-Technique) that attempted to develop quantitative measures of subjective data. Thus trait markers of the personality and typical features of the relationships of the different groups of depressive patients were investigated in the so called symptomless interval.

Section snippets

Methods

The study focuses on the subjective appraisal of the self concept and of the self object relations of patients suffering from affective disorders. Dimensions which are significant for the self-esteem regulation and interaction dynamics of depressive patients were empirically explored in the so-called free interval. The one point measurement of individually centred data can be regarded as an initial rapprochement to complex intrapsychic and interactional processes. The aim was to investigate

Sample

One hundred and twenty-seven inpatients affected by an affective and schizoaffective disorder admitted to the psychiatric university hospital of Frankfurt/Main were included into this study. Diagnoses were assigned by two independent psychiatrists on the basis of interviews and medical records, according to ICD10-criteria (Table 1). The final study sample consisted of those patients whose HAMD-score was below 10 prior to dismission. All patients were receiving psychopharmalogical treatment.

Results

The HAMD total score of the depressive sample was 5.66 (S.D. 4.94). It was significantly higher than that of the orthopaedic sample 3.50; (S.D. 2.13, Mann–Whitney U-test: P<0.05).

The self esteem of the depressive sample operationalized on the basis of self-idealself-, self-normative-self-, and idealself-normative self-distances did not differ significantly from that of the controls (Fig. 2). The level of the self esteem did not correlate with sociodemographic characteristics.

Comparing the three

Discussion

This study is the first to use the Repertory Grid Technique in order to assess personality traits and object relations of patients suffering from affective disorders. In contrast to former studies that used standardised personality inventories only the methodological approach of this study permits to record quantitative measurements of subjective phenomena. The evaluation of distribution patterns of the self-idealself–partner relations in the self-ideal–object system revealed that the partners

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