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Published in: BMC Psychiatry 1/2016

Open Access 01-12-2016 | Research article

Psychopathological Functioning Levels (PFLs) and their possible relevance in psychiatric treatments: a qualitative research project

Authors: Andrea Ferrero, Barbara Simonelli, Simona Fassina, Elisabetta Cairo, Giovanni Abbate-Daga, Enrica Marzola, Secondo Fassino

Published in: BMC Psychiatry | Issue 1/2016

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Abstract

Background

Symptoms description is often not enough to provide clinicians with guidelines for treatments and patients’ clinical history does not represent an exhaustive source of data. Psychopathological dysfunctions are known to relate to the core disturbances that underlie different forms of psychopathology so the identification of such dysfunctions could be helpful for treatments. Some tools are available although highly complex and lengthy. This study aimed to provide clinicians with an easy-to-administer instrument able to capture different levels of impairment in psychopathological functioning, namely the Psychopathological Functioning Levels – Rating Scale (PFL-RS).

Methods

The Psychopathological Functioning Level - Research and Training Committee (PFL-RTC) has been established in Turin since 2002 including psychiatrists and clinical psychologists with extensive clinical and research experience. Our research was grounded on the Qualitative Research Criteria (QRC) 1-7 and conducted with subsequent steps in order to identify those core psychopathological dysfunctions to be rated by this tool.

Results

From 2002 until 2014, 316 outpatients were administered the clinical interview on at least two different occasions. Diagnoses were mixed and included: Schizophrenic and Psychotic Disorders, Depressive Disorders, Anxiety Disorders, Obsessive-Compulsive Disorder, Post- Traumatic Stress Disorder, Somatic Symptoms Disorders, Eating Disorders and Personality Disorders. Focus groups were conducted to identify those psychopathological dysfunctions which needed to be rated, according to two Phenomenological Selection Criteria (PhSC) and four Etiopathogenetic Selection Criteria (EtSC). As a result, five dysfunctional areas emerged: Identity (ID); Comprehension (CO); Negative Emotions (NE); Action-Regulation (AR); Social Skills (SS). After checking such dimensions for consistency with the existing instruments, 7 levels of severity were identified for each area. Finally, a provisional Italian schedule of Psychopathological Functioning Levels – Rating Scale (PFL-RS) was obtained and checked for semantic comprehension and then administered gathering preliminary data.

Conclusions

Psychopathological dysfunctions underlying mental disorders have been recognized in the present study with the PFL-RS. This instrument seems promising to inform in a specific way treatments strategies and goals, specifically concerning psychotherapy. Notwithstanding, further research is needed in order to confirm validity, sensitivity and reliability of this instrument.
Literature
1.
go back to reference Barron JW. Making diagnosis meaningful. Enhancing evaluation and treatment of psychological disorders. Washington D.C: American Psychological Association; 1998.CrossRef Barron JW. Making diagnosis meaningful. Enhancing evaluation and treatment of psychological disorders. Washington D.C: American Psychological Association; 1998.CrossRef
2.
go back to reference Kächele H. Operationalized psychodynamic diagnostics OPD-2. Manual of diagnosis and treatment planning. Psychother Res. 2009;19(1):125–7.CrossRef Kächele H. Operationalized psychodynamic diagnostics OPD-2. Manual of diagnosis and treatment planning. Psychother Res. 2009;19(1):125–7.CrossRef
3.
go back to reference Lingiardi V, Del Corno F. PDM – Manuale Diagnostico Psicodinamico. Presentazione dell’edizione italiana. Milano: Raffaello Cortina Editore; 2008. Lingiardi V, Del Corno F. PDM – Manuale Diagnostico Psicodinamico. Presentazione dell’edizione italiana. Milano: Raffaello Cortina Editore; 2008.
4.
go back to reference Kupfer DA, First MB, Regier DA. A research agenda for DSM–V. Washington D.C: American Psychiatric Publishing; 2002. Kupfer DA, First MB, Regier DA. A research agenda for DSM–V. Washington D.C: American Psychiatric Publishing; 2002.
5.
go back to reference First MB. Relational processes in the DSM-V revision process: comment on the special section. J Fam Psychol. 2006;20(3):356–8.CrossRefPubMed First MB. Relational processes in the DSM-V revision process: comment on the special section. J Fam Psychol. 2006;20(3):356–8.CrossRefPubMed
6.
go back to reference PDM Task Force. Psychodynamic Diagnostic Manual (PDM). Silver Spring: Alliance of Psychoanalytic Organizations; 2006. PDM Task Force. Psychodynamic Diagnostic Manual (PDM). Silver Spring: Alliance of Psychoanalytic Organizations; 2006.
7.
go back to reference Reiss D, Emde RN. Relationship disorders are psychiatric disorders: five reasons they were not included in DSM-IV. In: Phillips KA, First MB, Pinkus HA, editors. Advancing DSM. Washington D.C: American Psychiatric Association; 2003. Reiss D, Emde RN. Relationship disorders are psychiatric disorders: five reasons they were not included in DSM-IV. In: Phillips KA, First MB, Pinkus HA, editors. Advancing DSM. Washington D.C: American Psychiatric Association; 2003.
8.
go back to reference Beach SRH, Wamboldt MZ, Kaslow NJ, Heyman RE, First MB, Underwood LG, Reiss D., editors. Relational processes and DSM-V: Neuroscience, Assessment, Prevention, and Treatment. Washington, D.C: American Psychiatric Press; 2006. Beach SRH, Wamboldt MZ, Kaslow NJ, Heyman RE, First MB, Underwood LG, Reiss D., editors. Relational processes and DSM-V: Neuroscience, Assessment, Prevention, and Treatment. Washington, D.C: American Psychiatric Press; 2006.
9.
go back to reference Wakefield JC. The concept of mental disorder. On the boundary between biological facts and social values. Am Psychol. 1992;47(3):373–88.CrossRefPubMed Wakefield JC. The concept of mental disorder. On the boundary between biological facts and social values. Am Psychol. 1992;47(3):373–88.CrossRefPubMed
10.
go back to reference Kendler KS. A history of the DSM-5 Scientific Review Committee. Psychol Med. 2013;43(9):1793–800.CrossRefPubMed Kendler KS. A history of the DSM-5 Scientific Review Committee. Psychol Med. 2013;43(9):1793–800.CrossRefPubMed
11.
go back to reference Skodol AE. Personality disorder classification: stuck in neutral, how to move forward? Curr Psychiatry Rep. 2014;16(10):480.CrossRefPubMed Skodol AE. Personality disorder classification: stuck in neutral, how to move forward? Curr Psychiatry Rep. 2014;16(10):480.CrossRefPubMed
12.
go back to reference Koelen JA, Luyten P, Eurelings-Bontekoe LH, Diguer L, Vermote R, Lowyck B, Bühring ME. The impact of level of personality organization on treatment response: a systematic review. Psychiatry. 2012;75(4):355–74.CrossRefPubMed Koelen JA, Luyten P, Eurelings-Bontekoe LH, Diguer L, Vermote R, Lowyck B, Bühring ME. The impact of level of personality organization on treatment response: a systematic review. Psychiatry. 2012;75(4):355–74.CrossRefPubMed
13.
go back to reference Westen D, Shedler J. Revising and assessing axis II, Part II: toward an empirically based and clinically useful classification of personality disorders. Am J Psychiatry. 1999;156(2):273–85.PubMed Westen D, Shedler J. Revising and assessing axis II, Part II: toward an empirically based and clinically useful classification of personality disorders. Am J Psychiatry. 1999;156(2):273–85.PubMed
14.
go back to reference Good EM. Personality Disorders in the DSM-5: Proposed Revisions and Critiques. J Ment Health Couns. 2012;34(1):1–13.CrossRef Good EM. Personality Disorders in the DSM-5: Proposed Revisions and Critiques. J Ment Health Couns. 2012;34(1):1–13.CrossRef
15.
go back to reference Gore WL, Widiger TA. The DSM-5 dimensional trait model and five-factor models of general personality. J Abnorm Psychol. 2013;122(3):816–21.CrossRefPubMed Gore WL, Widiger TA. The DSM-5 dimensional trait model and five-factor models of general personality. J Abnorm Psychol. 2013;122(3):816–21.CrossRefPubMed
16.
go back to reference American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Washington D.C: American Psychiatric Association Publishing; 2013.CrossRef American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Washington D.C: American Psychiatric Association Publishing; 2013.CrossRef
17.
go back to reference Livesley WJ. Disorder in the proposed DSM-5 classification of personality disorders. Clin Psychol Psychother. 2012;19(5):364–8.CrossRefPubMed Livesley WJ. Disorder in the proposed DSM-5 classification of personality disorders. Clin Psychol Psychother. 2012;19(5):364–8.CrossRefPubMed
18.
go back to reference Leuzinger Bohleber M, Target M, editors. The outcomes of psychoanalytic treatment. London: Whurr; 2002. Leuzinger Bohleber M, Target M, editors. The outcomes of psychoanalytic treatment. London: Whurr; 2002.
19.
go back to reference Elliott R, Fischer CT, Rennie DL. Evolving guidelines for publication of qualitative research studies in psychology and related fields. Br J Clin Psychol. 1999;38(Pt 3):215–29.CrossRefPubMed Elliott R, Fischer CT, Rennie DL. Evolving guidelines for publication of qualitative research studies in psychology and related fields. Br J Clin Psychol. 1999;38(Pt 3):215–29.CrossRefPubMed
20.
go back to reference Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRefPubMed Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRefPubMed
21.
go back to reference Fassino S, Amianto F, Ferrero A. Brief Adlerian psychodynamic psychotherapy: theoretical issues and process indicators. Panminerva Med. 2008;50(2):165–75.PubMed Fassino S, Amianto F, Ferrero A. Brief Adlerian psychodynamic psychotherapy: theoretical issues and process indicators. Panminerva Med. 2008;50(2):165–75.PubMed
22.
go back to reference Ferrero A. The Model of Sequential Brief-Adlerian Psychodynamic Psychotherapy (SB-APP): Specific Features in the Treatment of Borderline Personality Disorder. Res Psychother. 2012;15(1):32–45. Ferrero A. The Model of Sequential Brief-Adlerian Psychodynamic Psychotherapy (SB-APP): Specific Features in the Treatment of Borderline Personality Disorder. Res Psychother. 2012;15(1):32–45.
23.
go back to reference Ferrero A. Une psychothérapie modulée sur le fonctionnement psychopathologique. Le modèle sur-mesure de la psychothérapie psychodynamique adlérienne. Paris: L’Harmattan; 2014. Ferrero A. Une psychothérapie modulée sur le fonctionnement psychopathologique. Le modèle sur-mesure de la psychothérapie psychodynamique adlérienne. Paris: L’Harmattan; 2014.
24.
go back to reference Updating Adlerian psychopathology according to scientific research: from precarity and its compensation to the “Vulnerability Events Personality – Psychopathological Model” (VEP-PM). Oral presentation at the 26th Congress of International Association of Individual Psychology. Paris; 2014 Updating Adlerian psychopathology according to scientific research: from precarity and its compensation to the “Vulnerability Events Personality – Psychopathological Model” (VEP-PM). Oral presentation at the 26th Congress of International Association of Individual Psychology. Paris; 2014
25.
go back to reference Adler A. Studie über Mindwertigkeit von Organen. Berlin-Wien: Urban & Scwarzenberg; 1907. Adler A. Studie über Mindwertigkeit von Organen. Berlin-Wien: Urban & Scwarzenberg; 1907.
26.
go back to reference Zubin J, Spring B. Vulnerability--a new view of schizophrenia. J Abnorm Psychol. 1977;86(2):103–26.CrossRefPubMed Zubin J, Spring B. Vulnerability--a new view of schizophrenia. J Abnorm Psychol. 1977;86(2):103–26.CrossRefPubMed
27.
go back to reference Rovera GG. Il sistema aperto dell’Individual-Psicologia. Quad Riv Psicol Indiv. 1979;4. Rovera GG. Il sistema aperto dell’Individual-Psicologia. Quad Riv Psicol Indiv. 1979;4.
28.
go back to reference Rovera GG. La Psicologia Individuale. In: Pancheri P, Cassano GB, editors. Trattato italiano di Psichiatria. Milano: Masson; 1992. Rovera GG. La Psicologia Individuale. In: Pancheri P, Cassano GB, editors. Trattato italiano di Psichiatria. Milano: Masson; 1992.
29.
30.
go back to reference Paris J. Borderline Personality Disorder: precursors, course, and outcome. Arlington: American Psychiatric Publishing; 2003. Paris J. Borderline Personality Disorder: precursors, course, and outcome. Arlington: American Psychiatric Publishing; 2003.
31.
go back to reference Fassino S, Abbate Daga G, Leombruni P. Manuale di psichiatria biopsicosociale. Torino: Centro Scientifico Editore; 2007. Fassino S, Abbate Daga G, Leombruni P. Manuale di psichiatria biopsicosociale. Torino: Centro Scientifico Editore; 2007.
32.
go back to reference Livesley WJ, Jang KL. The behavioral genetics of personality disorder. Annu Rev Clin Psychol. 2008;4:247–74.CrossRefPubMed Livesley WJ, Jang KL. The behavioral genetics of personality disorder. Annu Rev Clin Psychol. 2008;4:247–74.CrossRefPubMed
33.
go back to reference Svrakic DM, Lecic-Tosevski D, Divac-Jovanovic M. DSM axis II: personality disorders or adaptation disorders? Curr Opin Psychiatry. 2009;22(1):111–7.CrossRefPubMed Svrakic DM, Lecic-Tosevski D, Divac-Jovanovic M. DSM axis II: personality disorders or adaptation disorders? Curr Opin Psychiatry. 2009;22(1):111–7.CrossRefPubMed
34.
go back to reference Northoff G. Neuropsychoanalysis in practice. Brain, self, objects. New York: Oxford University Press; 2011.CrossRef Northoff G. Neuropsychoanalysis in practice. Brain, self, objects. New York: Oxford University Press; 2011.CrossRef
35.
go back to reference Stanghellini G, Fuchs T, editors. One century of Karl Jasper’s general psychopathology. Oxford: Oxford University Press; 2013. Stanghellini G, Fuchs T, editors. One century of Karl Jasper’s general psychopathology. Oxford: Oxford University Press; 2013.
36.
go back to reference Adler A. Über den nervösen Charakter. Wien: Bergmann; 1912. Adler A. Über den nervösen Charakter. Wien: Bergmann; 1912.
37.
go back to reference Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry. 1993;50(12):975–90.CrossRefPubMed Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry. 1993;50(12):975–90.CrossRefPubMed
38.
go back to reference Blatt SJ, Luyten P. A structural-developmental psychodynamic approach to psychopathology: two polarities of experience across the life span. Dev Psychopathol. 2009;21(3):793–814.CrossRefPubMed Blatt SJ, Luyten P. A structural-developmental psychodynamic approach to psychopathology: two polarities of experience across the life span. Dev Psychopathol. 2009;21(3):793–814.CrossRefPubMed
39.
go back to reference Tenbrink D. Betrachtungen zum Spannungsfeld zwischen individualpsychologischer Identität und psychoanalytischen Selbstverständnis in der Individualpsychologie. Zeit f Individualpsychol. 1998;23:95–115. Tenbrink D. Betrachtungen zum Spannungsfeld zwischen individualpsychologischer Identität und psychoanalytischen Selbstverständnis in der Individualpsychologie. Zeit f Individualpsychol. 1998;23:95–115.
40.
go back to reference Kernberg OF, Caligor E. A psychoanalytic theory of personality disorders. In: Lenzenweger MF, Clarkin F, editors. Major theories of personality disorders. 2nd ed. New York: Guilford; 2005. Kernberg OF, Caligor E. A psychoanalytic theory of personality disorders. In: Lenzenweger MF, Clarkin F, editors. Major theories of personality disorders. 2nd ed. New York: Guilford; 2005.
41.
go back to reference Stern BL, Caligor E, Clarkin JF, Critchfield KL, Horz S, MacCornack V, Lenzenweger MF, Kernberg OF. Structured Interview of Personality Organization (STIPO): preliminary psychometrics in a clinical sample. J Pers Assess. 2010;92(1):35–44.CrossRefPubMed Stern BL, Caligor E, Clarkin JF, Critchfield KL, Horz S, MacCornack V, Lenzenweger MF, Kernberg OF. Structured Interview of Personality Organization (STIPO): preliminary psychometrics in a clinical sample. J Pers Assess. 2010;92(1):35–44.CrossRefPubMed
42.
go back to reference Vermote R, Lowyck B, Luyten P, Verhaest Y, Vertommen H, Vandeneede B, Corveleyn J, Peuskens J. Patterns of inner change and their relation with patient characteristics and outcome in a psychoanalytic hospitalization-based treatment for personality disordered patients. Clin Psychol Psychother. 2011;18(4):303–13.CrossRefPubMed Vermote R, Lowyck B, Luyten P, Verhaest Y, Vertommen H, Vandeneede B, Corveleyn J, Peuskens J. Patterns of inner change and their relation with patient characteristics and outcome in a psychoanalytic hospitalization-based treatment for personality disordered patients. Clin Psychol Psychother. 2011;18(4):303–13.CrossRefPubMed
43.
go back to reference Fosha D, Siegel DJ, Solomon F, editors. The healing power of emotion. Affective Neuroscience, development and lineal prairie. New York-London: WW Norton & Company; 2009. Fosha D, Siegel DJ, Solomon F, editors. The healing power of emotion. Affective Neuroscience, development and lineal prairie. New York-London: WW Norton & Company; 2009.
44.
go back to reference Panksepp J. Affective consciousness: Core emotional feelings in animals and humans. Conscious Cogn. 2005;14(1):30–80.CrossRefPubMed Panksepp J. Affective consciousness: Core emotional feelings in animals and humans. Conscious Cogn. 2005;14(1):30–80.CrossRefPubMed
45.
go back to reference Panksepp J. Brain emotional systems and qualities of mental life: From animal models of affect to implications for psychotherapeutics. In: Fosha D, Siegel DJ, Solomon F, editors. The healing power of emotion. Affective Neuroscience, development and lineal prairie. New York-London: WW Norton & Company; 2009. Panksepp J. Brain emotional systems and qualities of mental life: From animal models of affect to implications for psychotherapeutics. In: Fosha D, Siegel DJ, Solomon F, editors. The healing power of emotion. Affective Neuroscience, development and lineal prairie. New York-London: WW Norton & Company; 2009.
46.
go back to reference Trevarthen C. The functions of emotion in infancy: The regulation and communication of rhythm, sympathy, and meaning in human development. In: Fosha D, Siegel DJ, Solomon F, editors. The healing power of emotion. Affective Neuroscience, development and clinical prairie. New York-London: WW Norton & Company; 2009. Trevarthen C. The functions of emotion in infancy: The regulation and communication of rhythm, sympathy, and meaning in human development. In: Fosha D, Siegel DJ, Solomon F, editors. The healing power of emotion. Affective Neuroscience, development and clinical prairie. New York-London: WW Norton & Company; 2009.
47.
go back to reference Bechara A. Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective. Nat Neurosci. 2005;8(11):1458–63.CrossRefPubMed Bechara A. Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective. Nat Neurosci. 2005;8(11):1458–63.CrossRefPubMed
48.
go back to reference Fonagy P, Allison E. The role of mentalizing and epistemic trust in the therapeutic relationship. Psychotherapy (Chic). 2014;51(3):372–80.CrossRef Fonagy P, Allison E. The role of mentalizing and epistemic trust in the therapeutic relationship. Psychotherapy (Chic). 2014;51(3):372–80.CrossRef
49.
go back to reference Northoff G. Unlocking the brain. Vol. 2, Consciousness. New York & Oxford: Oxford University Press; 2013.CrossRef Northoff G. Unlocking the brain. Vol. 2, Consciousness. New York & Oxford: Oxford University Press; 2013.CrossRef
50.
go back to reference Luyten P, Blatt SJ, Mayes LC. Process and outcome in psychoanalytic psychotherapy research: the need for a (relatively) new paradigm. In: Leyy RA et al., editors. Psychodynamic psychotherapy research: evidence-based practice and practice-based evidence. New York: Springer; 2012. Luyten P, Blatt SJ, Mayes LC. Process and outcome in psychoanalytic psychotherapy research: the need for a (relatively) new paradigm. In: Leyy RA et al., editors. Psychodynamic psychotherapy research: evidence-based practice and practice-based evidence. New York: Springer; 2012.
51.
go back to reference Tyrer P. The problem of severity in the classification of personality disorder. J Pers Disord. 2005;19(3):309–14.CrossRefPubMed Tyrer P. The problem of severity in the classification of personality disorder. J Pers Disord. 2005;19(3):309–14.CrossRefPubMed
52.
go back to reference Dazzi N. PDM – Manuale Diagnostico Psicodinamico. Introduzione alla parte III. Milano: Raffaello Cortina; 2008. Dazzi N. PDM – Manuale Diagnostico Psicodinamico. Introduzione alla parte III. Milano: Raffaello Cortina; 2008.
53.
go back to reference Crawford MJ, Koldobsky N, Mulder R, Tyrer P. Classifying personality disorder according to severity. J Pers Disord. 2011;25(3):321–30.CrossRefPubMed Crawford MJ, Koldobsky N, Mulder R, Tyrer P. Classifying personality disorder according to severity. J Pers Disord. 2011;25(3):321–30.CrossRefPubMed
54.
go back to reference Blatt SJ, Zuroff DC, Hawley LL, Auerbach JS. Predictors of sustained therapeutic change. Psychother Res. 2010;20(1):37–54.CrossRefPubMed Blatt SJ, Zuroff DC, Hawley LL, Auerbach JS. Predictors of sustained therapeutic change. Psychother Res. 2010;20(1):37–54.CrossRefPubMed
55.
go back to reference Northoff G, Bermpohl F, Schoeneich F, Boeker H. How does our brain constitute defense mechanisms? First-person neuroscience and psychoanalysis. Psychother Psychosom. 2007;76(3):141–53.CrossRefPubMed Northoff G, Bermpohl F, Schoeneich F, Boeker H. How does our brain constitute defense mechanisms? First-person neuroscience and psychoanalysis. Psychother Psychosom. 2007;76(3):141–53.CrossRefPubMed
56.
go back to reference Westen D, Gabbard GO, Blagow P. Back to the future: personality structure as a context for psychopathology. In: Krueger RF, Tackett JL, editors. Personality and psychopathology. New York: Guilford; 2006. Westen D, Gabbard GO, Blagow P. Back to the future: personality structure as a context for psychopathology. In: Krueger RF, Tackett JL, editors. Personality and psychopathology. New York: Guilford; 2006.
57.
go back to reference Gamache D, Laverdière O, Diguer L, Hébert E, Larochelle S, Descôteaux J. The personality organization diagnostic form: development of a revised version. J Nerv Ment Dis. 2009;197(5):368–77.CrossRefPubMed Gamache D, Laverdière O, Diguer L, Hébert E, Larochelle S, Descôteaux J. The personality organization diagnostic form: development of a revised version. J Nerv Ment Dis. 2009;197(5):368–77.CrossRefPubMed
58.
go back to reference Rudolf G, Grande T, Oberbracht C. Die Heidelberger Umstrukturierungsskala. Ein Modellder Veränderung in psychoanalytischen Therapien und seine Opationalisierung in einer Schätzskala. Psychotherapeut. 2000;45. Rudolf G, Grande T, Oberbracht C. Die Heidelberger Umstrukturierungsskala. Ein Modellder Veränderung in psychoanalytischen Therapien und seine Opationalisierung in einer Schätzskala. Psychotherapeut. 2000;45.
59.
go back to reference Caligor E, Clarkin JF. An object relation model of personality and personality pathology. In: Clarkin JF, Fonagy P, Gabbard GO, editors. Psychodynamic psychotherapy for personality disorders: a clinical handbook. Washington D.C: American Psychiatric Publishing; 2010. Caligor E, Clarkin JF. An object relation model of personality and personality pathology. In: Clarkin JF, Fonagy P, Gabbard GO, editors. Psychodynamic psychotherapy for personality disorders: a clinical handbook. Washington D.C: American Psychiatric Publishing; 2010.
60.
go back to reference Eurelings-Bontekoe EHM, Onnink A, Williams M, Snellen WM. A new approach to assessment of structural personality pathology. Theory-driven profile interpretation of the Dutch Short Form of the MMPI. New Ideas Psychol. 2008;2008(26):23–40.CrossRef Eurelings-Bontekoe EHM, Onnink A, Williams M, Snellen WM. A new approach to assessment of structural personality pathology. Theory-driven profile interpretation of the Dutch Short Form of the MMPI. New Ideas Psychol. 2008;2008(26):23–40.CrossRef
61.
go back to reference Kernberg OF. Borderline conditions and pathological narcissism. New York: Jason Aronson; 1975. Kernberg OF. Borderline conditions and pathological narcissism. New York: Jason Aronson; 1975.
62.
go back to reference Perry JC, Presniak MD, Olson TR. Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. Psychiatry. 2013;76(1):32–52.CrossRefPubMed Perry JC, Presniak MD, Olson TR. Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. Psychiatry. 2013;76(1):32–52.CrossRefPubMed
63.
go back to reference Gunderson JG. Seeking clarity for future revisions of the personality disorders in DSM-5. Personal Disord. 2013;4(4):368–76.CrossRefPubMed Gunderson JG. Seeking clarity for future revisions of the personality disorders in DSM-5. Personal Disord. 2013;4(4):368–76.CrossRefPubMed
64.
go back to reference Paris J. Anatomy of a debacle: commentary on “seeking clarity for future revisions of the personality disorders in DSM-5”. Personal Disord. 2013;4(4):377–8.CrossRefPubMed Paris J. Anatomy of a debacle: commentary on “seeking clarity for future revisions of the personality disorders in DSM-5”. Personal Disord. 2013;4(4):377–8.CrossRefPubMed
65.
go back to reference Lyons-Ruth K. The Two-Person Construction of Defenses: Disorganized Attachment Strategies, Unintegrated Mental States, and Hostjle/Helpless Relational Processes. J Infant Child Adolesc Psychother. 2003;2:105–14.PubMedPubMedCentral Lyons-Ruth K. The Two-Person Construction of Defenses: Disorganized Attachment Strategies, Unintegrated Mental States, and Hostjle/Helpless Relational Processes. J Infant Child Adolesc Psychother. 2003;2:105–14.PubMedPubMedCentral
66.
67.
go back to reference Bruschweiler-Stern N, Lyons-Ruth K, Morgan AC, Nahum JP, Sander LW, Stern DN. The foundational level of psychodynamic meaning: implicit process in relation to conflict, defense and the dynamic unconscious. Int J Psychoanal. 2007;88(Pt 4):843–60.CrossRefPubMed Bruschweiler-Stern N, Lyons-Ruth K, Morgan AC, Nahum JP, Sander LW, Stern DN. The foundational level of psychodynamic meaning: implicit process in relation to conflict, defense and the dynamic unconscious. Int J Psychoanal. 2007;88(Pt 4):843–60.CrossRefPubMed
68.
go back to reference Bond M. Empirical studies of defense style: relationships with psychopathology and change. Harv Rev Psychiatry. 2004;12(5):263–78.CrossRefPubMed Bond M. Empirical studies of defense style: relationships with psychopathology and change. Harv Rev Psychiatry. 2004;12(5):263–78.CrossRefPubMed
69.
go back to reference American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association Publishing; 2000. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association Publishing; 2000.
70.
go back to reference Bond M, Wesley S. Manual for the Defense Style Questionnaire. Montreal: McGill University; 1996. Bond M, Wesley S. Manual for the Defense Style Questionnaire. Montreal: McGill University; 1996.
71.
go back to reference Perry JC. Defense Mechanism Rating Scales. 4th ed. Cambridge: Harvard University Press; 1986. Perry JC. Defense Mechanism Rating Scales. 4th ed. Cambridge: Harvard University Press; 1986.
72.
go back to reference Zeigler-Hill V, Pratt D. Defense Styles and the Interpersonal Circumplex: The Interpersonal Nature of Psychological Defense. J Psych Psychol Ment Health. 2007;1(2):1–15. Zeigler-Hill V, Pratt D. Defense Styles and the Interpersonal Circumplex: The Interpersonal Nature of Psychological Defense. J Psych Psychol Ment Health. 2007;1(2):1–15.
73.
go back to reference Morbach W. Die geteilte Wirklichkeit: Zur interakti-onellen Dynamik der Abwehrmechanismen. Z Individ. 2007;32:107–26. Morbach W. Die geteilte Wirklichkeit: Zur interakti-onellen Dynamik der Abwehrmechanismen. Z Individ. 2007;32:107–26.
74.
go back to reference Olson TR, Presniak MD, MacGregor MW. Differentiation of depression and anxiety groups using defense mechanisms. J Nerv Ment Dis. 2009;197(11):834–40.CrossRefPubMed Olson TR, Presniak MD, MacGregor MW. Differentiation of depression and anxiety groups using defense mechanisms. J Nerv Ment Dis. 2009;197(11):834–40.CrossRefPubMed
75.
go back to reference Presniak MD, Olson TR, Macgregor MW. The role of defense mechanisms in borderline and antisocial personalities. J Pers Assess. 2010;92(2):137–45.CrossRefPubMed Presniak MD, Olson TR, Macgregor MW. The role of defense mechanisms in borderline and antisocial personalities. J Pers Assess. 2010;92(2):137–45.CrossRefPubMed
76.
go back to reference Hersoug AG. Assessment of therapists’ and patients’ personality: relationship to therapeutic technique and outcome in brief dynamic psychotherapy. J Pers Assess. 2004;83(3):191–200.CrossRefPubMed Hersoug AG. Assessment of therapists’ and patients’ personality: relationship to therapeutic technique and outcome in brief dynamic psychotherapy. J Pers Assess. 2004;83(3):191–200.CrossRefPubMed
77.
go back to reference Pierò A, Cairo E, Ferrero A. Personality dimensions and working alliance in subjects with borderline personality disorder. Rev Psiquiatr Salud Ment. 2013;6(1):17–25.CrossRefPubMed Pierò A, Cairo E, Ferrero A. Personality dimensions and working alliance in subjects with borderline personality disorder. Rev Psiquiatr Salud Ment. 2013;6(1):17–25.CrossRefPubMed
78.
go back to reference Ferrero A, Simonelli B. Sequential Brief-Adlerian Psychodynamic Psychotherapy (SB-APP): “psicoterapia a tempo limitato” per pazienti con organizzazione borderline di personalità. Riv Psicol Indiv. 2006;59:13–38. Ferrero A, Simonelli B. Sequential Brief-Adlerian Psychodynamic Psychotherapy (SB-APP): “psicoterapia a tempo limitato” per pazienti con organizzazione borderline di personalità. Riv Psicol Indiv. 2006;59:13–38.
79.
go back to reference Ferrero A, Cairo E, Fassina S, Pierò A, Simonelli B. Short Brief Adlerian Psychodynamic Psychotherapy (SB-APP): technical issues for the treatment of aggressiveness in patients with Borderline Personality Organization (BPO). Pan Min Med. 2009;51(3):39. Ferrero A, Cairo E, Fassina S, Pierò A, Simonelli B. Short Brief Adlerian Psychodynamic Psychotherapy (SB-APP): technical issues for the treatment of aggressiveness in patients with Borderline Personality Organization (BPO). Pan Min Med. 2009;51(3):39.
80.
go back to reference Amianto F, Ferrero A, Pierò A, Cairo E, Rocca G, Simonelli B, Fassina S, Abbate-Daga G, Fassino S. Supervised team management, with or without structured psychotherapy, in heavy users of a mental health service with borderline personality disorder: a two-year follow-up preliminary randomized study. BMC Psychiatry. 2011;11:181.CrossRefPubMedPubMedCentral Amianto F, Ferrero A, Pierò A, Cairo E, Rocca G, Simonelli B, Fassina S, Abbate-Daga G, Fassino S. Supervised team management, with or without structured psychotherapy, in heavy users of a mental health service with borderline personality disorder: a two-year follow-up preliminary randomized study. BMC Psychiatry. 2011;11:181.CrossRefPubMedPubMedCentral
81.
go back to reference Bender DS, Morey LC, Skodol AE. Toward a model for assessing level of personality functioning in DSM-5, part I: a review of theory and methods. J Pers Assess. 2011;93(4):332–46.CrossRefPubMed Bender DS, Morey LC, Skodol AE. Toward a model for assessing level of personality functioning in DSM-5, part I: a review of theory and methods. J Pers Assess. 2011;93(4):332–46.CrossRefPubMed
82.
go back to reference Ferrero A. Psychopathological functioning level and their possible relevance in psychotherapy for borderline and other personality disorders. Poster presentation at the third Congress on Borderline Personality Disorder and Allied Disorders. Rome; 2014. Ferrero A. Psychopathological functioning level and their possible relevance in psychotherapy for borderline and other personality disorders. Poster presentation at the third Congress on Borderline Personality Disorder and Allied Disorders. Rome; 2014.
83.
go back to reference Ferrero A, Pierò A, Fassina S, Massola T, Lanteri A, Daga GA, Fassino S. A 12-month comparison of brief psychodynamic psychotherapy and pharmacotherapy treatment in subjects with generalised anxiety disorders in a community setting. Eur Psychiatry. 2007;22(8):530–9.CrossRefPubMed Ferrero A, Pierò A, Fassina S, Massola T, Lanteri A, Daga GA, Fassino S. A 12-month comparison of brief psychodynamic psychotherapy and pharmacotherapy treatment in subjects with generalised anxiety disorders in a community setting. Eur Psychiatry. 2007;22(8):530–9.CrossRefPubMed
84.
go back to reference Guy W, Clinical Global Impression. ECDEU assessment manual for psychopharmacology revised. Rockville: National Institute of Mental Health; 1976. Guy W, Clinical Global Impression. ECDEU assessment manual for psychopharmacology revised. Rockville: National Institute of Mental Health; 1976.
85.
go back to reference Derogatis LR. SCL-90-R Symptom Checklist-90-R. Firenze: Giunti O.S; 1994. Derogatis LR. SCL-90-R Symptom Checklist-90-R. Firenze: Giunti O.S; 1994.
86.
go back to reference Lieb K, Stoffers JM, Völlm BA. Comparative efficacy of evidence-based psychotherapies in the treatment of borderline personality disorder. Oral presentation at the 3rd International Congress of Borderline Personality Disorder and Allied Disorders - ESSPD 2014. Roma; 2014 Lieb K, Stoffers JM, Völlm BA. Comparative efficacy of evidence-based psychotherapies in the treatment of borderline personality disorder. Oral presentation at the 3rd International Congress of Borderline Personality Disorder and Allied Disorders - ESSPD 2014. Roma; 2014
87.
go back to reference Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologists Press; 1983. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologists Press; 1983.
88.
go back to reference Beck A, Ward C, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psych. 1961;4:561–71.CrossRef Beck A, Ward C, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psych. 1961;4:561–71.CrossRef
89.
go back to reference Spielberger CD. State-trait anger expression inventory: Professional manual. Odessa: Psychological Assessment Resources; 1996. Spielberger CD. State-trait anger expression inventory: Professional manual. Odessa: Psychological Assessment Resources; 1996.
90.
go back to reference Lowyck B, Luyten P, Verhaest Y, Vandeneede B, Vermote R. Levels of personality functioning and their association with clinical features and interpersonal functioning in patients with personality disorders. J Pers Disord. 2013;27(3):320–36.CrossRefPubMed Lowyck B, Luyten P, Verhaest Y, Vandeneede B, Vermote R. Levels of personality functioning and their association with clinical features and interpersonal functioning in patients with personality disorders. J Pers Disord. 2013;27(3):320–36.CrossRefPubMed
91.
go back to reference Deyo RA, Carter WB. Strategies for improving and expanding the application of health status measures in clinical settings. A researcher-developer viewpoint. Med Care. 1992;30(5 Suppl):MS176–186. discussion MS196-209.PubMed Deyo RA, Carter WB. Strategies for improving and expanding the application of health status measures in clinical settings. A researcher-developer viewpoint. Med Care. 1992;30(5 Suppl):MS176–186. discussion MS196-209.PubMed
92.
go back to reference Sundbom E, Jacobsson L, Kullgren G, Penayo U. Personality and defenses: a cross-cultural study of psychiatric patients and healthy individuals in Nicaragua and Sweden. Psychol Rep. 1998;83(3 Pt 2):1331–47.CrossRefPubMed Sundbom E, Jacobsson L, Kullgren G, Penayo U. Personality and defenses: a cross-cultural study of psychiatric patients and healthy individuals in Nicaragua and Sweden. Psychol Rep. 1998;83(3 Pt 2):1331–47.CrossRefPubMed
93.
go back to reference Markon KE, Krueger RF, Watson D. Delineating the structure of normal and abnormal personality: an integrative hierarchical approach. J Pers Soc Psychol. 2005;88(1):139–57.CrossRefPubMedPubMedCentral Markon KE, Krueger RF, Watson D. Delineating the structure of normal and abnormal personality: an integrative hierarchical approach. J Pers Soc Psychol. 2005;88(1):139–57.CrossRefPubMedPubMedCentral
Metadata
Title
Psychopathological Functioning Levels (PFLs) and their possible relevance in psychiatric treatments: a qualitative research project
Authors
Andrea Ferrero
Barbara Simonelli
Simona Fassina
Elisabetta Cairo
Giovanni Abbate-Daga
Enrica Marzola
Secondo Fassino
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-016-0940-4

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