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Depression and Personality Dysfunction: Towards the Understanding of Complex Depression

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Depression and Personality Dysfunction

Part of the book series: Depression and Personality ((DP))

Abstract

This introductory chapter presents a focused survey of the literature on the interaction between depression and personality, which represents one of the approaches to the issue of complex depression, which is treated from different perspectives throughout this book. Patients who, in addition to a depression, present with personality dysfunction are more than twice as likely to be nonresponders to treatment compared to patients with common, stand-alone depression. Furthermore, personality styles and the level of structural integration of personality are, as well, related to severity and to the response to treatment. For this reason, in order to assess complex depression and to improve treatment, it is important to deepen our understanding of the interaction of depression and personality. We examine this issue from the perspective of functional domains that are differentially affected in depression concurrent with personality dysfunction and specific personality styles, as well as how the co-occurrence of both impacts on the severity of the condition. The chapter outlines the complex and multimodal relationships between depression and personality dysfunction, discussing specific models for the interaction between depression and borderline personality disorder, on one hand, and personality styles and structural personality integration, on the other hand.

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References

  • Akiskal, H. S., & McKinney, W. T. (1973). Depressive disorders: Toward a unified hypothesis: Clinical, experimental, genetic, biochemical, and neurophysiological data are integrated. Science, 182(4107), 20–29.

    Article  Google Scholar 

  • Behn, A. (2019). Working with clients at the intersection of depression and personality dysfunction: Scientific and clinical findings regarding complex depression. Journal of Clinical Psychology, 75(5), 819–823.

    Article  Google Scholar 

  • Behn, A., Herpertz, S. C., & Krause, M. (2018). The interaction between depression and personality dysfunction: State of the art, current challenges, and future directions. Introduction to the Special Section. Psykhe, 27(2), 1–12.

    Article  Google Scholar 

  • Berenson, K. R., Downey, G., Rafaeli, E., Coifman, K. G., & Paquin, N. L. (2011). The rejection–rage contingency in borderline personality disorder. Journal of Abnormal Psychology, 120(3), 681.

    Article  Google Scholar 

  • Blatt, S. J. (1974). Levels of object representation in anaclitic and introjective depression. The Psychoanalytic Study of the Child, 29, 107–157.

    Article  Google Scholar 

  • Blatt, S. J. (2004). Experiences of depression: Theoretical, clinical and research perspectives. Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • Blatt, S. J. (2008). Two primary configurations of psychopathology. In S. Blatt (Ed.), Polarities of experiences: Relatedness and self-definition in personality development, psychopathology and the therapeutic process (pp. 234–245). Washington, DC: American Psychological Association.

    Google Scholar 

  • Blatt, S. J., D’Afflitti, J. P., & Quinlan, D. M. (1976). Experiences of depression in normal young adults. Journal of Abnormal Psychology, 85, 383–389.

    Article  Google Scholar 

  • Blatt, S. J., & Zuroff, D. C. (1992). Interpersonal relatedness and self-definition: Two prototypes for depression. Clinical Psychology Review, 12, 527–562.

    Article  Google Scholar 

  • Blatt, S. J., Zohar, A. H., Quinlan, D. M., Zuroff, D. C., & Mongrain, M. (1995). Subscales within the dependency factor of the Depressive Experiences Questionnaire. Journal of Personality Assessment, 64(2), 319–339.

    Google Scholar 

  • Bo, S., & Kongerslev, M. (2017). Self-reported patterns of impairments in mentalization, attachment, and psychopathology among clinically referred adolescents with and without borderline personality pathology. Borderline Personality Disorder and Emotion Dysregulation, 4(1), 4.

    Article  Google Scholar 

  • Buch, A. M., & Liston, C. (2020). Dissecting diagnostic heterogeneity in depression by integrating neuroimaging and genetics. Neuropsychopharmacology, 46, 1–22.

    Google Scholar 

  • Cai, N., Choi, K. W., & Fried, E. I. (2020). Reviewing the genetics of heterogeneity in depression: Operationalizations, manifestations, and etiologies. Human Molecular Genetics. Ahead of Print. https://doi.org/10.1093/hmg/ddaa115.

  • Choi-Kain, L. W., & Gunderson, J. G. (2015). Conclusion: Integration and synthesis. In Borderline personality and mood disorders (pp. 255–270). New York, NY: Springer.

    Chapter  Google Scholar 

  • Craighead, W. E., & Dunlop, B. W. (2014). Combination psychotherapy and antidepressant medication treatment for depression: For whom, when, and how. Annual Review of Psychology, 65, 267–300.

    Article  Google Scholar 

  • Dagnino, P. (2015). Structural vulnerabilities of depression. In Millennium nucleus research program “psychological intervention and change in depression” meeting. Santiago, Chile: Universidad de Chile.

    Google Scholar 

  • Dagnino, P., Pérez, C., Gómez, A., Gloger, S., & Krause, M. (2017). Depression and attachment: How do personality styles and social support influence this relation? Research in Psychotherapy: Psychopathology, Process and Outcome, 20, 53–62. https://doi.org/10.4081/ripppo.2017.237

    Article  Google Scholar 

  • de la Parra, G., Dagnino, P., Valdés, C., & Krause, M. (2017). Beyond self-criticism and dependency: Structural functioning of depressive patients and its treatment. Research in Psychotherapy: Psychopathology, Process and Outcome, 20, 43–52. https://doi.org/10.4081/ripppo.2017.236

    Article  Google Scholar 

  • De Panfilis, C., Ossola, P., Tonna, M., Catania, L., & Marchesi, C. (2015). Finding words for feelings: The relationship between personality disorders and alexithymia. Personality and Individual Differences, 74, 285–291.

    Article  Google Scholar 

  • DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy versus medication for depression: Treatment outcomes and neural mechanisms. Nature Reviews Neuroscience, 9(10), 788–796.

    Article  Google Scholar 

  • Dimaggio, G., & Brüne, M. (2016). Dysfunctional understanding of mental states in personality disorders: What is the evidence? Comprehensive Psychiatry, 64, 1–3.

    Article  Google Scholar 

  • Dixon-Gordon, K. L., Peters, J. R., Fertuck, E. A., & Yen, S. (2017). Emotional processes in borderline personality disorder: An update for clinical practice. Journal of Psychotherapy Integration, 27(4), 425.

    Article  Google Scholar 

  • Fertuck, E. A., Karan, E., & Stanley, B. (2016). The specificity of mental pain in borderline personality disorder compared to depressive disorders and healthy controls. Borderline Personality Disorder and Emotion Dysregulation, 3(1), 2.

    Article  Google Scholar 

  • Friborg, O., Martinsen, E. W., Martinussen, M., Kaiser, S., Øvergård, K. T., & Rosenvinge, J. H. (2014). Comorbidity of personality disorders in mood disorders: A meta-analytic review of 122 studies from 1988 to 2010. Journal of Affective Disorders, 152, 1–11.

    Article  Google Scholar 

  • Frodl, T., Möller, H. J., & Meisenzahl, E. (2008). Neuroimaging genetics: New perspectives in research on major depression? Acta Psychiatrica Scandinavica, 118(5), 363–372.

    Article  Google Scholar 

  • Goodman, M., Chowdhury, S., New, A. S., & Siever, L. J. (2015). Depressive disorders in borderline personality disorder: Phenomenology and biological markers. In Borderline personality and mood disorders (pp. 13–37). New York, NY: Springer.

    Chapter  Google Scholar 

  • Goodman, M., New, A. S., Triebwasser, J., Collins, K. A., & Siever, L. (2010). Phenotype, endophenotype, and genotype comparisons between borderline personality disorder and major depressive disorder. Journal of Personality Disorders, 24(1), 38–59.

    Article  Google Scholar 

  • Gunderson, J. G., & Phillips, K. A. (1991). A current view of the interface between borderline personality disorder and depression. The American Journal of Psychiatry, 148(8), 967–975.

    Article  Google Scholar 

  • Hart, A. B., Craighead, W. E., & Craighead, L. W. (2001). Predicting recurrence of major depressive disorder in young adults: A prospective study. Journal of Abnormal Psychology, 110(4), 633.

    Article  Google Scholar 

  • Hasler, G., Drevets, W. C., Manji, H. K., & Charney, D. S. (2004). Discovering endophenotypes for major depression. Neuropsychopharmacology, 29(10), 1765–1781.

    Article  Google Scholar 

  • Herpertz, S. C., Huprich, S. K., Bohus, M., Chanen, A., Goodman, M., Mehlum, L.,... & Sharp, C. (2017). The challenge of transforming the diagnostic system of personality disorders. Journal of personality disorders, 31(5), 577–589.

    Google Scholar 

  • Herpertz, S., Steinmeyer, E. M., & Saß, H. (1998). On the conceptualisation of subaffective personality disorders. European Psychiatry, 13(1), 9–17.

    Article  Google Scholar 

  • Hirsch, J. B., Quilty, L. C., Bagby, R. M., & McMain, S. F. (2012). The relationship between agreeableness and the development of the working alliance in patients with borderline personality disorder. Journal of Personality Disorders, 26(4), 616–627.

    Article  Google Scholar 

  • Klein, D. N. (2010). Chronic depression: diagnosis and classification. Current Directions in Psychological Science, 19(2), 96–100.

    Google Scholar 

  • Klein, D. N., Kotov, R., & Bufferd, S. J. (2011). Personality and depression: Explanatory models and review of the evidence. Annual Review of Clinical Psychology, 7, 269–295.

    Article  Google Scholar 

  • Köhling, J., Ehrenthal, J. C., Levy, K. N., Schauenburg, H., & Dinger, U. (2015). Quality and severity of depression in borderline personality disorder: A systematic review and meta-analysis. Clinical Psychology Review, 37, 13–25.

    Article  Google Scholar 

  • Köhling, J., Moessner, M., Ehrenthal, J. C., Bauer, S., Cierpka, M., Kämmerer, A., … Dinger, U. (2016). Affective instability and reactivity in depressed patients with and without borderline pathology. Journal of Personality Disorders, 30(6), 776–795.

    Article  Google Scholar 

  • Kramer, U., Vaudroz, C., Ruggeri, O., & Drapeau, M. (2013). Biased thinking assessed by external observers in borderline personality disorder. Psychology and Psychotherapy: Theory, Research and Practice, 86(2), 183–196.

    Article  Google Scholar 

  • Lépine, J. P., & Briley, M. (2011). The increasing burden of depression. Neuropsychiatric Disease and Treatment, 7(Suppl 1), 3.

    Google Scholar 

  • Levenson, J. C., Wallace, M. L., Fournier, J. C., Rucci, P., & Frank, E. (2012). The role of personality pathology in depression treatment outcome with psychotherapy and pharmacotherapy. Journal of Consulting and Clinical Psychology, 80(5), 719–729. https://doi.org/10.1037/a0029396

    Article  Google Scholar 

  • Lieb, K., Zanarini, M. C., Schmahl, C., Linehan, M. M., & Bohus, M. (2004). Borderline personality disorder. The Lancet, 364(9432), 453–461.

    Article  Google Scholar 

  • Livesley, W. J., Dimaggio, G., & Clarkin, J. F. (Eds.). (2015). Integrated treatment for personality disorder: A modular approach. New York, NY: Guilford Publications.

    Google Scholar 

  • Mancke, F., Herpertz, S. C., Kleindienst, N., & Bertsch, K. (2017). Emotion dysregulation and trait anger sequentially mediate the association between borderline personality disorder and aggression. Journal of Personality Disorders, 31(2), 256–272.

    Article  Google Scholar 

  • Markowitz, J. C., Skodol, A. E., & Bleiberg, K. (2006). Interpersonal psychotherapy for borderline personality disorder: Possible mechanisms of change. Journal of Clinical Psychology, 62, 431–444.

    Article  Google Scholar 

  • Newton-Howes, G., Tyrer, P., Johnson, T., Mulder, R., Kool, S., Dekker, J., & Schoevers, R. (2014). Influence of personality on the outcome of treatment in depression: Systematic review and meta-analysis. Journal of Personality Disorders, 28, 577–593.

    Article  Google Scholar 

  • Olhaberry, M., Mena, C., Zapata, J., Miranda, A., Romero, M., & Sieverson, C. (2015). Terapia de interacción guiada en díadas madre-bebé con sintomatología depresiva materna en el embarazo: un estudio piloto. [Guided interaction therapy in mother-baby dyads with maternal depressive symptomatology in pregnancy: A pilot study]. Summa Psicológica UST, 12(2), 63–74.

    Article  Google Scholar 

  • OPD Task Force (Ed.). (2008). Operationalized psychodynamic diagnosis OPD-2: Manual of diagnosis and treatment planning. Cambridge, MA: Hogrefe Publishing.

    Google Scholar 

  • Paris, J., & Zweig-Frank, H. (2001). The 27-year follow-up of patients with borderline personality disorder. Comprehensive Psychiatry, 42(6), 482–487.

    Article  Google Scholar 

  • Rodríguez, E., Ruiz, J. C., Valdés, C., Reinel, M., Díaz, M., Flores, J., … Tomicic, A. (2017). Estilos de personalidad dependiente y autocrítico: desempeño cognitivo y sintomatología depresiva [Dependent and self-critical personality styles: Cognitive performance and depressive symptomatology]. Latinoamericana de Psicología, 49, 2. https://doi.org/10.1016/j.rlp.2016.09.005

    Article  Google Scholar 

  • Schauenburg, H., Dinger, U., Komo-Lang, M., Klinkerfuss, M., Horsch, L., Grande, T., & Ehrenthal, J. C. (2012). Der OPD Strukturfragebogen [The OPD structure questionnaire]. In S. Döring & S. Hörz (Eds.), Handbuch der Strukturdiagnostik (pp. 284–307). Stuttgart, Germany: Schattauer.

    Google Scholar 

  • Schulze, L., Schmahl, C., & Niedtfeld, I. (2016). Neural correlates of disturbed emotion processing in borderline personality disorder: A multimodal meta-analysis. Biological Psychiatry, 79(2), 97–106.

    Article  Google Scholar 

  • Sharp, C., Venta, A., Vanwoerden, S., Schramm, A., Ha, C., Newlin, E., … Fonagy, P. (2016). First empirical evaluation of the link between attachment, social cognition and borderline features in adolescents. Comprehensive Psychiatry, 64, 4–11.

    Article  Google Scholar 

  • Shiffman, S., Stone, A. A., & Hufford, M. R. (2008). Ecological momentary assessment. Annual Review of Clinical Psychology, 4, 1–32.

    Article  Google Scholar 

  • Silva, J. R., Vivanco-Carlevari, A., Barrientos, M., Martínez, C., Salazar, L. A., & Krause, M. (2017). Biological stress reactivity as an index of the two polarities of the experience model. Psychoneuroendocrinology, 84, 83–86.

    Article  Google Scholar 

  • Skodol, A. E., Grilo, C. M., Keyes, K. M., Geier, T., Grant, B. F., & Hasin, D. S. (2011). Relationship of personality disorders to the course of major depressive disorder in a nationally representative sample. American Journal of Psychiatry, 168(3), 257–264. https://doi.org/10.1176/appi.ajp.2010.10050695

    Article  Google Scholar 

  • Spijker, J., van Straten, A., Bockting, C. L., Meeuwissen, J. A., & van Balkom, A. J. (2013). Psychotherapy, antidepressants, and their combination for chronic major depressive disorder: a systematic review. The Canadian Journal of Psychiatry, 58(7), 386–392.

    Google Scholar 

  • Staebler, K., Helbing, E., Rosenbach, C., & Renneberg, B. (2011). Rejection sensitivity and borderline personality disorder. Clinical Psychology & Psychotherapy, 18(4), 275–283.

    Google Scholar 

  • Stein, D. J., Hollander, E., & Skodol, A. E. (1993). Anxiety disorders and personality disorders: A review. Journal of Personality Disorders, 7(2), 87–104.

    Article  Google Scholar 

  • Vos, T., Haby, M. M., Barendregt, J. J., Kruijshaar, M., Corry, J., & Andrews, G. (2004). The burden of major depression avoidable by longer-term treatment strategies. Archives of General Psychiatry, 61(11), 1097–1103.

    Article  Google Scholar 

  • Wiegand, H. F., & Godemann, F. (2017). Increased treatment complexity for major depressive disorder for inpatients with comorbid personality disorder. Psychiatric Services, 68(5), 524–527.

    Article  Google Scholar 

  • Zanarini, M. C. (2018). In the fullness of time: Recovery from borderline personality disorder. New York, NY: Oxford University Press.

    Book  Google Scholar 

  • Zimmermann, J., Ehrenthal, J. C., Cierpka, M., Schauenburg, H., Doering, S., & Benecke, C. (2012). Assessing the level of structural integration using operationalized psychodynamic diagnosis (OPD): Implications for DSM-5. Journal of Personality Assessment, 94, 522–532.

    Article  Google Scholar 

  • Zufferey, P., Caspar, F., & Kramer, U. (2019). The role of interactional agreeableness in responsive treatments for patients with borderline personality disorder. Journal of Personality Disorders, 33(5), 691–706.

    Article  Google Scholar 

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Acknowledgments

This work was funded by the ANID-Millennium Science Initiative/Millennium Institute for Research on Depression and Personality-MIDAP.

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Authors and Affiliations

  1. Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile

    Mariane Krause & Alex Behn

  2. Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile

    Mariane Krause & Alex Behn

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  1. Mariane Krause
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Editors and Affiliations

  1. Millennium Institute for Research in Depression and Personality; Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, RM - Santiago, Chile

    Guillermo de la Parra

  2. Millennium Institute for Research in Depression and Personality; Faculty of Psychology, Universidad Alberto Hurtado, Santiago, RM - Santiago, Chile

    Paula Dagnino

  3. Millennium Institute for Research in Depression and Personality; School of Psychology, Pontificia Universidad Católica de Chile, Santiago, RM - Santiago, Chile

    Alex Behn

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Krause, M., Behn, A. (2021). Depression and Personality Dysfunction: Towards the Understanding of Complex Depression. In: de la Parra, G., Dagnino, P., Behn, A. (eds) Depression and Personality Dysfunction. Depression and Personality. Springer, Cham. https://doi.org/10.1007/978-3-030-70699-9_1

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