Taak 2 Avoidant and dependent PD
Avoidant PD
Leising Characteristic interpersonal behavior in dependent and avoidant personality
disorder can be observed within very short interaction sequences
- We present a behavior observation study of interpersonal behavior in 96 female
subjects, who had been screened for the presence of dependent, avoidant, narcissistic
and histrionic personality disorder features. Each subject took part in three short role-
plays, taken from assertiveness training. Afterwards, both the subject and her role-play
partner judged, how assertive the subject had been. Although observation time was
very short, dependent and avoidant subjects could be easily identified from their
overly submissive behavior in the role-plays. Histrionic and narcissistic subjects did
not show distinctive interpersonal behavior. Contrary to a common belief, higher
scores on some personality disorder (PD) scales were positively related to cross-
situational variability of behavior. Results are discussed with regard to their
implications for clinical diagnostics, therapy and the methodology of personality
disorder research in general.
- In investigating interpersonal behavior, it is reasonable to distinguish between two
aspects: (1) quality of behavior and (2) variability of behavior.
- circumplex model of interpersonal behavior:
The first (vertical) axis quantifies the status,
power or control someone claims for himself
and is often called dominance. The second
(horizontal) axis describes how much
friendliness or love a person displays and is
often called affiliation.
- the question if (or under what circumstances)
good mental health is associated with
behavioral stability or variability remains to be
answered definitively.
- we expected that subjects with narcissistic or
histrionic personality features would show increased levels of dominance, while
subjects with avoidant or dependent personality features would behave in a more
submissive manner.
- the subjects were asked to take part in three short role-plays, taken from assertiveness
training. Within the role-plays, the subjects’ task was to assert themselves against a
waitress (who brought a bad drink), a friend (who wants to borrow some money), and
a sales representative (who wants to sell christmas cards at the front-door). The three
role plays will be abbreviated W (Waitress), F (Friend) and SR (Sales Representative)
in the following. For each subject, the three situations occurred in random order. All
three characters were played by the same confederate (D.S.), who had no knowledge
of the SCID-II diagnoses given by the interviewer. At the end of each of the three role-
plays, both the subject and the confederate judged how assertive the subject had been,
using the dominance (PA) and submissiveness (HI) scales of the Interpersonal
Adjectives Scales Revised.
- Subjects with features of dependent or avoidant personality disorder showed
characteristic, that is: submissive interpersonal behavior in the role-plays. This is a
remarkable result, as observation time was restricted to only a few minutes, and the
confederate was completely unacquainted to the subjects. Still, the distinctive behavior
pattern became obvious under these conditions.
1
, - subjects with HPD or NPD did not show distinctive behavior in the role-plays. There
are two possible explanations for this: First, as we had asked our subjects to be as
assertive as possible, it may have become difficult for the histrionic and narcissistic
subjects to stand out as even more dominant than the other subjects (ceiling-effect).
Second, it may be that the Dominance axis of the interpersonal circumplex is not as
important in describing HPD and NPD as we had expected.
- subjects with higher scores on some of the PDs scales were more variable in their
behavior across the role-plays. Role-play F was particularly important in this respect.
- we strongly recommend an increased use of observational paradigms in personality
disorder research. Identifying and observing specific “behaviors-in-situations” that are
critical for adaptive interpersonal functioning may help us to better understand how
and why certain people get into the same kind of interpersonal difficulties again and
again.
Lobbestael
- avoidant: vroege maladaptieve schema’s, cognitieve interpretation bias,
interpretatiebias van aflezen gezichten.
Torvik: Longitudinal Associations Between Social Anxiety Disorder and Avoidant
Personality Disorder: A Twin Study
- Social anxiety disorder (SAD) and avoidant personality disorder (AvPD) are
frequently co-occurring psychiatric disorders with symptomatology related to fear of
social situations. It is uncertain to what degree the 2 disorders reflect the same genetic
and environmental risk factors. The current study addresses the stability and co-
occurrence of SAD and AvPD, the factor structure of the diagnostic criteria, and
genetic and environmental factors underlying the disorders at 2 time points. SAD and
AvPD were assessed in 1,761 young adult female twins at baseline and 1,471 of these
approximately 10 years later. Biometric models were fitted to dimensional
representations of SAD and AvPD. SAD and AvPD were moderately and
approximately equally stable from young to middle adulthood, with increasing
cooccurrence driven by environmental factors. At the first wave, approximately 1 in 3
individuals with AvPD had SAD, increasing to 1 in 2 at follow-up. The diagnostic
criteria for SAD and AvPD had a two-factor structure with low cross-loadings. The
relationship between SAD and AvPD was best accounted for by a model with
separate, although highly correlated, and highly heritable risk factors for each
disorder. Their genetic and environmental components correlated .84 and .59,
respectively. The finding of partially distinct risk factors indicates qualitative
differences in the etiology of SAD and AvPD. Genetic factors represented the
strongest time-invariant influences, whereas environmental factors were most
important at the specific points in time.
- A long-standing question is whether avoidant personality disorder is best understood
as a severe variant of social anxiety disorder. This study finds that there are important
differences in risk factors for the 2 disorders. The disorders share genetic risk factors
to a substantial degree, but the environment is most important in determining whether
the disorders manifest.
- The assessment of SAD and AvPD on two occasions makes it possible to estimate
common and disorder-specific risk factors more precisely. In the current study, we had
the following specific aims: First, to assess the stability of SAD and AvPD from early
to middle adulthood. Second, to estimate the co-occurrence between SAD and AvPD
at both waves. Third, to investigate whether SAD and AvPD at the two waves are best
accounted for by one or two underlying risk factors. Fourth, to examine genetic and
2
Avoidant PD
Leising Characteristic interpersonal behavior in dependent and avoidant personality
disorder can be observed within very short interaction sequences
- We present a behavior observation study of interpersonal behavior in 96 female
subjects, who had been screened for the presence of dependent, avoidant, narcissistic
and histrionic personality disorder features. Each subject took part in three short role-
plays, taken from assertiveness training. Afterwards, both the subject and her role-play
partner judged, how assertive the subject had been. Although observation time was
very short, dependent and avoidant subjects could be easily identified from their
overly submissive behavior in the role-plays. Histrionic and narcissistic subjects did
not show distinctive interpersonal behavior. Contrary to a common belief, higher
scores on some personality disorder (PD) scales were positively related to cross-
situational variability of behavior. Results are discussed with regard to their
implications for clinical diagnostics, therapy and the methodology of personality
disorder research in general.
- In investigating interpersonal behavior, it is reasonable to distinguish between two
aspects: (1) quality of behavior and (2) variability of behavior.
- circumplex model of interpersonal behavior:
The first (vertical) axis quantifies the status,
power or control someone claims for himself
and is often called dominance. The second
(horizontal) axis describes how much
friendliness or love a person displays and is
often called affiliation.
- the question if (or under what circumstances)
good mental health is associated with
behavioral stability or variability remains to be
answered definitively.
- we expected that subjects with narcissistic or
histrionic personality features would show increased levels of dominance, while
subjects with avoidant or dependent personality features would behave in a more
submissive manner.
- the subjects were asked to take part in three short role-plays, taken from assertiveness
training. Within the role-plays, the subjects’ task was to assert themselves against a
waitress (who brought a bad drink), a friend (who wants to borrow some money), and
a sales representative (who wants to sell christmas cards at the front-door). The three
role plays will be abbreviated W (Waitress), F (Friend) and SR (Sales Representative)
in the following. For each subject, the three situations occurred in random order. All
three characters were played by the same confederate (D.S.), who had no knowledge
of the SCID-II diagnoses given by the interviewer. At the end of each of the three role-
plays, both the subject and the confederate judged how assertive the subject had been,
using the dominance (PA) and submissiveness (HI) scales of the Interpersonal
Adjectives Scales Revised.
- Subjects with features of dependent or avoidant personality disorder showed
characteristic, that is: submissive interpersonal behavior in the role-plays. This is a
remarkable result, as observation time was restricted to only a few minutes, and the
confederate was completely unacquainted to the subjects. Still, the distinctive behavior
pattern became obvious under these conditions.
1
, - subjects with HPD or NPD did not show distinctive behavior in the role-plays. There
are two possible explanations for this: First, as we had asked our subjects to be as
assertive as possible, it may have become difficult for the histrionic and narcissistic
subjects to stand out as even more dominant than the other subjects (ceiling-effect).
Second, it may be that the Dominance axis of the interpersonal circumplex is not as
important in describing HPD and NPD as we had expected.
- subjects with higher scores on some of the PDs scales were more variable in their
behavior across the role-plays. Role-play F was particularly important in this respect.
- we strongly recommend an increased use of observational paradigms in personality
disorder research. Identifying and observing specific “behaviors-in-situations” that are
critical for adaptive interpersonal functioning may help us to better understand how
and why certain people get into the same kind of interpersonal difficulties again and
again.
Lobbestael
- avoidant: vroege maladaptieve schema’s, cognitieve interpretation bias,
interpretatiebias van aflezen gezichten.
Torvik: Longitudinal Associations Between Social Anxiety Disorder and Avoidant
Personality Disorder: A Twin Study
- Social anxiety disorder (SAD) and avoidant personality disorder (AvPD) are
frequently co-occurring psychiatric disorders with symptomatology related to fear of
social situations. It is uncertain to what degree the 2 disorders reflect the same genetic
and environmental risk factors. The current study addresses the stability and co-
occurrence of SAD and AvPD, the factor structure of the diagnostic criteria, and
genetic and environmental factors underlying the disorders at 2 time points. SAD and
AvPD were assessed in 1,761 young adult female twins at baseline and 1,471 of these
approximately 10 years later. Biometric models were fitted to dimensional
representations of SAD and AvPD. SAD and AvPD were moderately and
approximately equally stable from young to middle adulthood, with increasing
cooccurrence driven by environmental factors. At the first wave, approximately 1 in 3
individuals with AvPD had SAD, increasing to 1 in 2 at follow-up. The diagnostic
criteria for SAD and AvPD had a two-factor structure with low cross-loadings. The
relationship between SAD and AvPD was best accounted for by a model with
separate, although highly correlated, and highly heritable risk factors for each
disorder. Their genetic and environmental components correlated .84 and .59,
respectively. The finding of partially distinct risk factors indicates qualitative
differences in the etiology of SAD and AvPD. Genetic factors represented the
strongest time-invariant influences, whereas environmental factors were most
important at the specific points in time.
- A long-standing question is whether avoidant personality disorder is best understood
as a severe variant of social anxiety disorder. This study finds that there are important
differences in risk factors for the 2 disorders. The disorders share genetic risk factors
to a substantial degree, but the environment is most important in determining whether
the disorders manifest.
- The assessment of SAD and AvPD on two occasions makes it possible to estimate
common and disorder-specific risk factors more precisely. In the current study, we had
the following specific aims: First, to assess the stability of SAD and AvPD from early
to middle adulthood. Second, to estimate the co-occurrence between SAD and AvPD
at both waves. Third, to investigate whether SAD and AvPD at the two waves are best
accounted for by one or two underlying risk factors. Fourth, to examine genetic and
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