Retrospect and Prospect Patrick Luyten University of Leuven and University College London Sidney J. Blatt Yale University Two-polarities models of personality propose that person- ality development evolves through a dialectic synergistic interaction between two fundamental developmental psy- chological processes across the life spanthe development of interpersonal relatedness on the one hand and of self- denition on the other. This article offers a broad review of extant research concerning these models, discusses their implications for psychology and psychiatry, and addresses future research perspectives deriving from these models. We rst consider the implications of ndings in this area for clinical research and practice. This is followed by a discussion of emerging research ndings concerning the role of developmental, cross-cultural, evolutionary, and neurobiological factors inuencing the development of these two fundamental personality dimensions. Taken to- gether, this body of research suggests that theoretical formulations that focus on interpersonal relatedness and self-denition as central coordinates in personality devel- opment and psychopathology provide a comprehensive conceptual paradigm for future research in psychology and psychiatry exploring the interactions among neurobiolog- ical, psychological, and sociocultural factors in adaptive and disrupted personality development across the life span. Keywords: personality, attachment, psychopathology, cross-cultural, neurobiology I nterpersonal relatedness and self-denition have been central developmental dimensions in a large number of diverse theoretical and empirical contributions con- cerning normal and disrupted personality development (Ba- kan, 1966; Blatt, 2008; Freud, 1930; Wiggins, 1991). Re- latedness and self-denition refer to fundamental psychological developmental issues and processes in- volved in the development of the capacity to establish and maintain, respectively, (a) reciprocal, meaningful, and per- sonally satisfying interpersonal relationships and (b) a co- herent, realistic, differentiated, and essentially positive sense of self, or an identity. These two developmental dimensions have been central in personality theories across a wide variety of disciplines, ranging from philosophy and evolutionary and cross-cultural psychology to personality and social psychology and psychoanalysis (for an extensive review, see Blatt, 2008). Various personality theories have referred to these dimensions as surrender and autonomy (Angyal, 1951); communion and agency (Bakan, 1966; Pincus, 2005); afliation (or intimacy) and achievement (or power) (McAdams, 1985; McClelland, 1985); anaclitic and introjective (Blatt, 1974, 2008); relatedness and au- tonomy/competence (Deci & Ryan, 2012; Ryan & Deci, 2000); and, more recently, attachment anxiety and attach- ment avoidance (Mikulincer & Shaver, 2007; Sibley, 2007) and sociotropy and autonomy (Beck, 1983; Clark & Beck, 1999). As several authors have pointed out before (Luyten & Blatt, 2011; Mikulincer & Shaver, 2007; Pincus, 2005), these so-called two-polarities models of personality share an emphasis on the dialectic interaction between issues of relatedness and self-denition in personality development as well as a number of other key assumptions concerning the nature of adaptive and disrupted personality devel- opment. The centrality of these two fundamental psychological dimensions of relatedness and self-denition in theories of personality development across different disciplines calls for a review of relevant empirical research concerning them. This review is all the more timely given the inuence of these theories on the planning for the upcoming fth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (Bender, Morey, & Skodol, 2011; Lowyck, Luyten, Verhaest, Vandeneede, & Vermote, in press) and particularly given a newly emerging body of research demonstrating the role of cross-cultural, biologi- cal, and evolutionary factors, and their interactions, in the development of these dimensions. Here we rst discuss research concerning the conver- gence among the most prominent current two-polarities models and their implications for understanding personal- ity development and for conceptualizing, classifying, and treating psychopathology. Next, we take a broader perspec- tive and consider the impact of developmental factors, gender, and sociocultural issues on the development of Patrick Luyten, Faculty of Psychology and Educational Sciences, Univer- sity of Leuven, Leuven, Belgium, and Research Department of Clinical, Educational and Health Psychology, University College London, London, England; Sidney J. Blatt, Department of Psychiatry (professor emeritus), Yale University. Correspondence concerning this article should be addressed to Patrick Luyten, University of Leuven, Tiensestraat 102, P.O. Box 3722, 3000 Leuven, Belgium, or Sidney J. Blatt, Department of Psy- chiatry, Yale University, New Haven, CT 06511. E-mail: patrick.luyten@psy.kuleuven.be or sidney.blatt@yale.edu 172 April 2013
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b r o a d l y . these dimensions, and we present evidence concerning their neurobiological and evolutionary foundations. In each section, we consider the implications of these views for contemporary psychology and psychiatry. We argue that a focus on these two fundamental developmental psycholog- ical processes has considerable theoretical and empirical utility by providing a comprehensive conceptual matrix that integrates views concerning normal and disrupted per- sonality development and the respective inuence of evo- lutionary, biological, and sociocultural factors, and their interactions, on personality development. Two-Polarities Models of Personality Development Adaptive Personality Development As described in detail elsewhere (Luyten & Blatt, 2011), current research efforts concerning two-polarities models of personality development derive primarily from the fol- lowing approaches: (a) Blatts (2008) two-congurations model, (b) Becks (1983) cognitive personality model, (c) contemporary interpersonal formulations, (d) current at- tachment approaches, and (e) Deci and Ryans (2012) self-determination theory. These models share the assump- tion that adaptive personality development proceeds through a continuous dialectic interaction between issues of relatedness and self-denition (Blatt & Luyten, 2009; Mi- kulincer & Shaver, 2007). Beginning in early infancy, interpersonal relatedness is thought to contribute to the development of the sense of self, which then in turn con- tributes to the development of more mature levels of inter- personal relatedness. From psychodynamic and cognitive developmental perspectives, Blatt and colleagues (Blatt, 2008; Blatt & Luyten, 2009; Blatt & Shichman, 1983) have argued that development of the sense of self leads to increasingly mature levels of interpersonal relatedness that, in turn, facilitate further differentiation and integration in the de- velopment of the self. Beck (1983, Clark & Beck, 1999) similarly distinguished sociotropy and autonomy. Auton- omy refers to an achievement-oriented personality style associated with attempts to maximize control over the environment. Sociotropy involves investment in and at- tachment to others. Beck similarly proposed that a balance between autonomy and sociotropy characterizes adaptive personality development. Studies have shown consistent differences associated with these two personality dimen- sions in current and early life experiences (Blatt & Homann, 1992; Blatt & Luyten, 2009; Soenens, Vansteen- kiste, & Luyten, 2010), stress responsivity (Luyten, Corve- leyn, & Blatt, 2005; Luyten et al., 2011), and interpersonal and attachment styles (Luyten et al., 2005; Zuroff, Mon- grain, & Santor, 2004). Current interpersonal models have proposed similar dimensions that underlie personality development: agency (or social dominance) and communion (or nurturance or afliation) (Benjamin, 2005; Horowitz & Strack, 2011; Horowitz et al., 2006; Kiesler, 1983; Leary, 1957; Pincus, 2005; Wiggins, 1991, 2003). These dimensions have been shown to overlap both theoretically and empirically with self-denition/autonomy and relatedness/sociotropy, re- spectively (Luyten & Blatt, 2011). Contemporary attach- ment theory, in turn, equally emphasizes the importance of a balance between relatedness and self-denition in per- sonality development (Mikulincer & Shaver, 2007). An increasing consensus now views two dimensions as under- lying attachment behaviorattachment avoidance and at- tachment anxiety (Meyer & Pilkonis, 2005; Mikulincer & Shaver, 2007; Roisman et al., 2007)that are expressed in differences in internal working models (IWMs) of self and of others (Bartholomew & Horowitz, 1991), that is, the set of expectations, beliefs, and feelings with regard to self and others that individuals develop as a result of interactions with attachment gures. Attachment avoidance, expressed in IWMs characterized by discomfort with closeness and discomfort with depending on others (Mikulincer & Shaver, 2007, p. 87), overlaps conceptually and empirically with the self-denition/autonomy/dominance dimension (Luyten & Blatt, 2011; Sibley, 2007; Sibley & Overall, 2007, 2008, 2010). Attachment anxiety, expressed in IWMs characterized by fear of rejection and abandon- ment (Mikulincer & Shaver, 2007, p. 155), overlaps with the relatedness/sociotropy/warmth dimension. Adaptive personality functioning in contemporary attachment formu- lations is similarly conceptualized as a balance between relatedness and self-denition, expressed in low to moder- ate levels of attachment anxiety and avoidance typical of securely attached individuals (Mikulincer & Shaver, 2007). Self-determination theory (Deci & Ryan, 2012; Ryan & Deci, 2000, 2006) advanced very similar views about personality development from a motivational perspective. Intrinsic or autonomous motivation, characteristic of adap- tive personality development, is assumed to involve a bal- ance between autonomy and competence on the one hand and relatedness on the other. Autonomy and competence reect strivings toward control over the initiation and out- come of ones activities, while relatedness refers to the need to feel related to others. Again, empirical research has provided evidence for the conceptual and empirical overlap of self-determination theorys focus on autonomy/compe- tence and relatedness with the other two-polarities models (Luyten & Blatt, 2011; Shahar, Henrich, Blatt, Ryan, & Little, 2003; Shahar, Kalnitzki, Shulman, & Blatt, 2006; Soenens, Park, Vansteenkiste, & Mouratidis, 2012; Zuroff, Koestner, Moskowitz, McBride, & Bagby, 2012). Although a detailed discussion of these ndings is beyond the scope of this article, relatedness and self-de- nition have also been theoretically and empirically related to major empirically derived personality models such as the ve factor model and other multivariate personality mod- els, including the tripartite personality model and internal- izing/externalizing spectrum models (Blatt & Luyten, 2010; Luyten & Blatt, 2011). In addition, expressions of relatedness and self-denition have been shown to be as- sociated with a host of variables beyond more basic per- sonality dimensions such as negative affectivity/neuroti- cism and extraversion (see Luyten & Blatt, 2011, for an 173 April 2013
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b r o a d l y . extensive overview), further emphasizing their explanatory power. Disruptions in Personality Development: Implications for the Conceptualization, Classification, and Treatment of Psychopathology Two-polarities models also converge to suggest that differ- ent forms of psychopathology are best conceptualized in terms of distorted modes of adaptation that derive, at dif- ferent developmental levels, from variations and disrup- tions in the synergistic interaction between aspects of re- latedness and self-denition throughout the life span. Different forms of psychopathology are thus viewed as distorted attempts to maintain a balance, however maladap- tive, between relatedness and self-denition, resulting in an excessive emphasis on one developmental line to the ne- glect of the other (Blatt, 2008; Luyten & Blatt, 2011; Meyer & Pilkonis, 2005; Mikulincer & Shaver, 2007). Congruent with these assumptions, studies indicate that various personality disorders can be organized into two congurationsone focused around issues of relatedness (an anaclitic conguration) and the other focused around issues of self-denition (an introjective conguration; see summary in Blatt & Luyten, 2010). For instance, re- search has shown that individuals with features of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition; American Psychiatric Association, 1994) de- pendent, histrionic, and borderline personality disorders tend to have signicantly greater concern with issues of interpersonal relatedness than with issues of self-denition. Individuals with features of antisocial, narcissistic, para- noid, schizoid, schizotypic, avoidant, and obsessive-com- pulsive disorders, by contrast, are more preoccupied with issues of self-denition (Blatt & Luyten, 2010; Luyten & Blatt, 2011). Inuenced by Livesleys (2008) seminal work and by two-polarities models (for a discussion, see Bender et al., 2011), the DSM-5 Personality and Personality Disorders Work Group (Skodol & Bender, 2009) has recently em- phasized the centrality of interpersonal relatedness and self-denition in understanding and classifying personality disorders (Skodol & Bender, 2009; Skodol et al., 2011; and see http://www.dsm5.org). The central scientic and phil- osophical principles guiding the revisions (Skodol, 2011, p. 97) by this work group have been based on the funda- mental assumption that personality disorders are associ- ated with distorted thinking about self and others and that maladaptive patterns of mentally representing the self and others serve as substrates for personality pathology (Skodol, 2011, p. 99). Specically, the DSM-5 Personality and Personality Disorders Work Group proposed that dif- ferent levels of impairments in levels of self-denition and interpersonal functioning are central to dening personality disorders, which range from no impairment to extreme impairments as expressed in a profound inability to reect on the self together with severe impairments in selfother boundaries (self-impairments) and in signicant impair- ments in the awareness and understanding of the thoughts, feelings, and motivations of others (interpersonal impair- ments) (Skodol, 2012). These proposals have now been included in Section 3 of the forthcoming DSM-5, meaning that they will be the subject of considerable further research and eld trials in the near future and will inform subsequent editions of the DSM (Skodol, 2012). It is noteworthy that studies in this context have gen- erally not found evidence for a one-to-one relationship between these two personality dimensions and current de- scriptive DSM diagnoses (Ouimette & Klein, 1993). Hence, the same issues with relatedness and self-denition may be expressed in different ways at different ages and in different contexts, a phenomenon consistent with the de- velopmental principles of equinality and multinality (Cicchetti & Rogosch, 1996) (Luyten & Blatt, 2011, p. 60). Levy, Edell, and McGlashan (2007), for example, found that patients with a DSM-IV diagnosis of borderline personality disorder (BPD) showed substantial symptom- atic heterogeneity. Yet these authors were able to identify within this symptomatically heterogeneous group a more interpersonally oriented (anaclitic) type and a more self- critical (introjective) type of BPD patient, in whom is- sues with relatedness and self-denition, respectively, pre- dominated. Finding such as these have very important implica- tions for conceptualizing, classifying, and treating psycho- pathology. Indeed, fundamental differences in underlying personality organization may provide a more coherent way of differentiating both within and between various disor- ders than a classication system based on manifest symp- toms, as in the DSM-IV. Congruent with this view, the DSM-5 Personality and Personality Disorders Work Group suggested dropping the dependent, histrionic, and schizoid personality disorders because of insufcient evidence sup- porting the distinctive nature of these disorders and thus their clinical utility (Skodol, 2012). Two-polarities models can contribute substantially to this discussion by providing a rigorous and empirically supported theoretical framework for evaluating the distinctiveness of specic personality disorders (Horowitz et al., 2006; Locke, 2010; Meyer & Pilkonis, 2005). As we have explained in more detail elsewhere (Luyten & Blatt, 2011), personality disorders (or clusters of personality disorder features) that are situated near each other in a two-dimensional space dened by relatedness and self-denition (see Figure 1) probably overlap to such an extent that clinically it may no longer be useful to distinguish between them (i.e., they are charac- terized by similar disturbances in relatedness and self- denition, despite potential differences in their symptom- atic expression). This could be the case for the histrionic, dependent, and anaclitic subgroups of borderline person- ality disorder because they have considerable overlap in terms of underlying disturbances in relatedness (Kernberg & Caligor, 2005; Luyten & Blatt, 2011). In contrast, per- sonality disorders (or clusters of personality disorder fea- tures) situated further apart in the two-dimensional space probably warrant consideration as separate disorders be- cause they have different underlying features (i.e., different types of disturbances in relatedness and self-denition). 174 April 2013
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b r o a d l y . Figure 1 presents such a prototype approach based on a two-dimensional space spanned by maladaptive expres- sions of relatedness and self-denition, using three com- mon personality disorders to illustrate this approach (Luyten & Blatt, 2011). Plotting personality disorder fea- tures in this two-dimensional space promises to clarify the distinctiveness as well as the notable comorbidity of per- sonality disorders in the DSM-IV based on their positioning in this two-dimensional space. The DSM-5 Personality and Personality Disorders Work Group has also questioned the distinction between Axis I (symptom) disorders and Axis II (personality) disorders. Again, ndings derived from research based on two-polarities models can inform this discussion. Studies have shown that various symptom disorders, currently subsumed under Axis I (i.e., mood disorders, several anx- iety disorders, substance abuse disorders, eating disorders, and somatoform disorders), are characterized by (tempo- rary or chronic) impairments in the sense of self and relatedness (for reviews, see Blatt, 2008; Blatt & Luyten, 2010; Egan, Wade, & Shafran, 2011; Zuroff et al., 2004). Hence, these ndings suggest that maladaptive expressions of relatedness and self-denition (such as dependency and self-critical perfectionism) can, therefore, best be concep- tualized as transdiagnostic vulnerability factors, which may also partly explain the high comorbidity among symptom and personality disorders and the longitudi- nal relationships among both types of disorders (Blatt & Luyten, 2010; Egan et al., 2011). From this perspective, it might also be more produc- tive for future research to investigate the efcacy and effectiveness of broad transdiagnostic treatments that ad- dress basic underlying personality issues (Egan et al., 2011; Kazdin, 2011; Luyten & Blatt, 2007, 2011; McHugh, Mur- ray, & Barlow, 2009) rather than continuing to focus on developing specic treatments for specic disorders. This assumption is further reinforced by research indicating that patients who are primarily preoccupied with issues of re- latedness or self-denition are differentially responsive to different aspects of the treatment process regardless of their specic diagnosis. Patients primarily preoccupied with is- sues of relatedness (i.e., anaclitic patients) are responsive mainly to supportive dimensions of interventions. Patients primarily preoccupied with issues of self-denition (i.e., introjective patients) have been shown to be more respon- sive to interpretiveexploratory dimensions (Blatt, Zuroff, Hawley, & Auerbach, 2010). Research in this context in fact suggests a parallel between normal psychological de- velopment and the processes of therapeutic change (Luyten, Blatt, & Mayes, 2012). Studies suggest that, just as in normal personality development, therapeutic change seems to result from a synergistic interaction of experi- ences of interpersonal relatedness and self-denition. Ther- apeutic change may thus result from the reactivation of a normal synergistic developmental process in which inter- personal experiences in the therapeutic relationship con- tribute to the development of the sense of self, leading to more mature expressions of interpersonal relatedness, which, in turn, further foster the development of the self (Safran, Muran, & Eubanks-Carter, 2011; Safran, Muran, Samstag, & Steven, 2002). Although further research is needed to explore more fully the factors that contribute to sustained therapeutic change, these ndings demonstrate the advantages of a theoretical model that proposes a par- allel between normal personality development and thera- peutic change. In summary, in contrast to a more static symptom- or disorder-centered approach, two-polarities models suggest that psychopathology reects attempts to achieve some stability or equilibrium in response to developmental dis- ruptions by becoming preoccupied, in exaggerated and distorted ways, at different developmental levels, with one or the other of these developmental dimensions of inter- personal relatedness and self-denition (Blatt, 2008; Luyten, Mayes, Target, & Fonagy, 2012). This approach, which links normal and pathological personality develop- ment with therapeutic processes, has considerable clinical utility, particularly as it furthers our understanding of the structure of psychopathology and the mechanisms of ther- apeutic change (Luyten & Blatt, 2011). Relatedness and Self-Definition Across the Life Span It is hard to imagine thinking about psychopathology in any way other than developmentally (Gluckman et al., 2009; Munir & Beardslee, 1999). From the perspective of two- polarities models, as discussed earlier, personality devel- opment evolves from infancy to senescence through a complex synergistic interaction between experiences of interpersonal relatedness and self-denition (Blatt, 2008). A large body of research supports the value of two- polarities models for understanding both normal and dis- rupted psychological development from childhood to ado- Figure 1 A Prototype Approach to Personality Disorder (PD) Based on Two-Polarities Models High self-criticism/ Attachment avoidance/ Dominance Low self-criticism/ Attachment avoidance/ Dominance High dependency/ Attachment anxiety/ Warmth Avoidant PD
Dependent PD Antisocial PD Low dependency/ Attachment anxiety/ Warmth Note. This approach is based on the work of Luyten and Blatt (2011), Pincus (2005), Meyer and Pilkonis (2005), and Horowitz et al. (2006). 175 April 2013
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b r o a d l y . lescence and adulthood (Blatt & Luyten, 2009; Mikulincer & Shaver, 2007; Sroufe, 1997; Sroufe, Carlson, Levy, & Egeland, 1999). For instance, two-polarities models have helped to elucidate the extensive comorbidity between in- ternalizing and externalizing disorders in childhood and adolescence (Krueger, Skodol, Livesley, Shrout, & Huang, 2007; Lahey et al., 2008) and their links to two types of depression (i.e., dependent and self-critical) in adolescence. For example, an excessive emphasis on and/or preoccupa- tion with issues concerning relatedness has been closely associated with the development of internalizing problems, especially in adolescent females (Besser, Vliegen, Luyten, & Blatt, 2008; Leadbeater, Kuperminc, Blatt, & Hertzog, 1999; Soenens et al., 2005). Excessive preoccupation with issues concerning self-denition, in turn, has been linked to the development of externalizing problems (e.g., delin- quency and aggression), especially in adolescent males (Leadbeater et al., 1999). Thus, two-polarities models have contributed to elucidating developmental pathways in- volved in internalizing and externalizing disorders in ado- lescence and the emergence of gender differences in these disorders. Studies based on two-polarities models have also in- creased our understanding of the intergenerational trans- mission of vulnerabilities for psychopathology. Attachment research, for example, has found considerable evidence for the role of early attachment disruptions in explaining vul- nerability for psychopathology across the life span (Cassidy & Shaver, 2008; Gunnar & Quevedo, 2007; Sroufe, 1997;Sroufe et al., 1999). As noted, studies in this context suggest that secure attachment involves a balance between relatedness and self-denition that contributes to the development of mature levels of interpersonal related- ness and an essentially positive sense of self and identity (Beebe et al., 2007; Blatt & Luyten, 2009). Attachment disruptions, however, seem to result in an overemphasis on issues of either relatedness or self-denition, expressed in anxious resistant (or enmeshed/preoccupied) or dismissing avoidant attachment patterns, respectively. It is common knowledge that these patterns were rst identied in chil- dren in research employing the Strange Situation procedure (Ainsworth, Blehar, Waters, & Wall, 1978) and were later replicated in adolescents and adults using the Adult Attach- ment Interview (George, Kaplan, & Main, 1985) and self- report measures (Mikulincer & Shaver, 2007). More re- cently, Beebe et al. (2007) found evidence for the very early emergence of these patterns in a study analyzing the moment-to-moment play interactions of 126 parentinfant dyads. They found that mothers who were overly preoccu- pied with issues concerning self-denition experienced dif- culties in engaging their 4-month-old infants attention and emotions. In an attempt to compensate for this rela- tional mismatch, these mothers had a tendency to touch their infants more, but their infants tended to withdraw and become more avoidant. Mothers preoccupied by related- ness issues, in contrast, showed excessive concern about emotional availability and tended to become overinvolved with their infants, leading to lowered self-regulation capac- ities in their infants. Similar ndings have been reported concerning parentchild interactions in adolescence (Soenens et al., 2010, 2012), suggesting that disproportion- ate concerns with relatedness and self-denition are trans- mitted across the generations. Congruent with this assump- tion, a study by Besser and Priel (2005), with a community sample of 300 participants (100 three-generation triads of women), reported evidence for the intergenerational trans- mission of excessive preoccupation with issues of related- ness and self-denition from mothers to their daughters and granddaughters. These studies demonstrate that two-polarities models facilitate a more detailed analysis of psychological pro- cesses involved in the intergenerational transmission of vulnerability for psychopathology from infancy to adoles- cence and adulthood. Moreover, these studies clearly imply that relatedness and self-denition do not develop in a sociocultural vacuum but are inuenced by gender and sociocultural issues. Gender and Sociocultural Influences on Relatedness and Self-Definition Issues of gender, culture, and environmental factors more generally are often neglected in the study of personality development, despite their importance (DiBartolo & Rendn, 2012; Fraley & Roberts, 2005). Two-polarities models have furthered our insights into the complex inter- actions among these factors, although much work remains to be done in this area. Two-polarities models view a balance between inter- personal relatedness and self-denition as a key feature of adaptive psychological functioning. Rather than patholo- gizing dependency, these models, and attachment research in particular, have thus played an important role in the recognition of interpersonal relatedness as a fundamental personality dimension and in recognizing differences among adaptive and maladaptive expressions of depen- dency (Blatt, 2008; Bornstein & Languirand, 2003). Fur- thermore, both Blatt (2008) and Beck (1983) have sug- gested that, at least within Western societies (which tend to value autonomy and self-denition in men, and relatedness and attachment in women), women place somewhat greater emphasis on relatedness, while men place more emphasis on self-denition. As a result, gender incongruence (i.e., high levels of dependency in men and a strong emphasis on self-denition in women) is devalued and has been hypoth- esized to be associated with increased risk for maladjust- ment, at least in Western cultures. In Western samples, women indeed report somewhat higher investment than men in issues of relatedness, but not on implicit measures, suggesting that men may overtly deny investment in relatedness (for reviews, see Blatt, 2008; Bornstein, 1992). In contrast, studies typically do not nd gender differences concerning the importance of self- denition, at least not in Western societies, which may reect cultural changes in gender roles in the West (Luyten et al., 2005). Moreover, although some evidence indicates the role of gender incongruence in explaining vulnerability for psychopathology, more research is denitely needed 176 April 2013
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b r o a d l y . (Luyten et al., 2007). However, some evidence suggests gender differences in the nature of psychopathology that are congruent with predictions made by two-polarities models. For instance, men are more prone to externalizing disorders and internalizing types of psychopathology that involve preoccupation with self-denition, while women are more prone to internalizing disorders such as somatic depression (i.e., depression characterized by anxious and somatic concerns) and functional somatic and personality disorders involving preoccupation with issues of related- ness (such as BPD; Besser, Luyten, Vliegen, & Blatt, 2008). Epidemiological studies, for example, suggest that somatic depression is twice as prevalent in women (Silver- stein, 2002) and may be related to sociocultural limitations placed upon womens striving for achievement (Silver- stein, Clauson, Perdue, Carpman, & Cimarolli, 1998). Sim- ilarly, hostile/irritable depression (Parker et al., 1999) and antisocial personality disorder (Beauchaine, Klein, Crow- ell, Derbidge, & Gatzke-Kopp, 2009), which involve in- tense preoccupation with self-denition, are typically more prevalent in men. It is important to bear in mind that these ndings are based on research in Western samples and that cultures differ in the extent to which they emphasize and value relatedness and self-denition. These differences may have a profound impact on the meaning and consequences of these dimensions across cultures (Soenens et al., 2012). It is often hypothesized in this context that relatedness is emphasized in collectivistic or interdependent cultures, while individualistic or independent cultures emphasize self-denition (Kagitcibasi, 2005; Kitayama, Markus, Ma- tsumoto, & Norasakkunkit, 1997; Markus & Kitayama, 1991; Triandis, 2001). Research has indeed provided evi- dence for mean level differences across cultures in empha- sis on issues of relatedness and self-denition (Matsumoto & Van de Vijver, 2011) as well as in maladaptive expres- sions of these dimensions. For example, Asian Americans have consistently been found to have higher levels of maladaptive perfectionisman expression of intense pre- occupation with self-denitionon self-report question- naires, compared with Caucasian Americans (DiBartolo & Rendn, 2012). These differences probably result from complex interactions among sociocultural factors such as levels of individualism versus collectivism in the social context, which may inuence parenting styles (Ahmad & Soenens, 2010; Chang & Asakawa, 2003; Kitayama et al., 1997). For instance, because of the relative emphasis on collectivism in interdependent cultures, parents in these cultures may place greater emphasis on relatedness in re- lation to their children than do parents in more individual- istic cultures. Yet caution is needed in this context. Although Asian cultures, for example, are often depicted as collectivist, research shows that this is an overly simplied view be- cause individualistic and collectivistic values often co- occur within the same culture (Ahmad & Soenens, 2010). Indeed, studies suggest that the strong emphasis on educa- tion and achievement by Asian American parents often coexists with parental concern and involvement (e.g., the Chinese concept of guanto love and care for in addition to govern; DiBartolo & Rendn, 2012; Soenens et al., 2012). Hence, both dimensions, relatedness and self-de- nition, need to be considered simultaneously (DiBartolo & Rendn, 2012). Two-polarities models open up interesting avenues for the study of the balance and interplay between relatedness and self-denition across cultures, particularly as increasing globalization is likely to affect this balance. For instance, the emphasis on interdependency in many so-called collectivist cultures is rapidly shifting toward a strong focus on achievement and independence, which has been related to an increase in internalizing problem behav- iors and disorders (e.g., depression and suicide) in these cultures (Im et al., 2011; Kwon, Chun, & Cho, 2009; Ministerio de Salud, Gobierno de Chile, 2010; Organisa- tion for Economic Co-Operation and Development, 2013). Rather than the new emphasis on achievement, it may be the disturbance in the deeply embedded cultural balance between relatedness and self-denition that may disorga- nize individuals and families within these cultures, leading to higher levels of maladjustment. While universalist positions in this context argue that high levels of dependency are maladaptive regardless of cultural context, a relativistic or cultural congruence per- spective argues that this may depend on the cultural context (Soenens et al., 2012). High levels of interdependency, for instance, are often seen as less maladaptive, or even as adaptive, in collectivistic cultures, whereas the emphasis on self-denition and personal achievement is often consid- ered normative and adaptive in individualistic cultures. It is important in this research not to conate adaptive with more maladaptive expressions of relatedness and self-def- inition (Soenens et al., 2012). For instance, studies suggest considerable structural invariance of measures of self-crit- ical perfectionism, a maladaptive expression of self-deni- tion, as well as similar patterns of negative relationships between self-critical perfectionism and mental health out- comes, across cultures (DiBartolo & Rendn, 2012). Hence, although self-critical perfectionism may be more congruent with predominant values in some cultures, it seems to confer risk for psychopathology across cultures, which is inconsistent with a relativistic or cultural con- gruence model. Likewise, person-centered approaches have identied similar subgroups of perfectionists across different ethnic groups, although research indicates subtle yet potentially important differences in the phenomenology and correlates of self-critical perfectionism in different ethnic groups. For example, congruent with research in Caucasian American samples, Herman, Trotter, Reinke, and Ialongo (2011) found evidence for noncritical/adap- tive, critical/maladaptive, and nonperfectionist clusters of children in a large sample of African American adoles- cents. However, they also identied an additional cluster of children who were characterized by extremely low levels of self-striving. Further analyses suggested that these low- striving children failed to develop healthy levels of self- striving because they grew up in poor, deprived neighbor- hoods, were the victim of racial and cultural prejudices, and thus had very limited prospects in life. Findings such as 177 April 2013
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b r o a d l y . these thus suggest both universal and culture-specic ori- gins of concerns with and expressions of self-denition. With regard to relatedness, studies have similarly reported factorial invariance of measures of relatedness and similar patterns of relationships with other variables in different cultures (e.g., high levels of dependency are associated with maladjustment regardless of culture; Ahmad & Soenens, 2010; Otani et al., 2012; Soenens et al., 2012) but also some important differences (e.g., in the distribution of preoccupied attachment) across cultures (Grossmann, Grossmann, Spangler, Suess, & Unzner, 1985; van IJzen- doorn & Sagi-Schwartz, 2008). More research is clearly needed across cultures, as well as in the identication and investigation of subgroups within cultures. Religious factors can also be important in this context, as they may differentially emphasize related- ness and self-denition and reinforce or weaken cultural patterns (Cohen & Hill, 2007). Cross-cultural studies have also typically been limited to Asian American and African American samples (Ahmad & Soenens, 2010; DiBartolo & Rendn, 2012). More research is also needed on the role of other environmental factors, such as early adversity, and the interaction of cultural factors with neurobiological and genetic factors, as discussed in the next section. Neurobiological and Evolutionary Basis of Relatedness and Self-Definition A recently emerging body of evidence concerning the neurobiological and evolutionary basis of issues of relat- edness and self-denition promises to lead to considerable advances in our understanding of normal and disrupted personality development across the life cycle, including the role of relatively stable versus stochastic and person-de- pendent (Fraley & Roberts, 2005) environmental factors and geneenvironment correlations and interactions. As noted, studies have found that parental preoccupations with issues of relatedness and self-denition are related to self- regulation and interactive regulation capacities in infants as young as 4 months of age (Beebe et al., 2007). These ndings are congruent with emerging evidence in both animals and humans concerning the central role of attach- ment experiences in programming the development of the hypothalamicpituitaryadrenal axis, the main human stress system (Gunnar, Quevedo, De Kloet, Oitzl, & Eric, 2008; Lupien, McEwen, Gunnar, & Heim, 2009; Neumann, 2008; Sbarra & Hazan, 2008). These ndings have led to the so-called developmental origins of health and disease paradigm (e.g., Gluckman et al., 2009), which essentially proposes that early programming effects play an important role in explaining vulnerability to both psychiatric and (functional) somatic disorders across the life span (Lupien et al., 2009). Studies in this eld promise to shed more light on interactions among genetic, physiological, neurobiolog- ical, and neural factors in the development of relatedness and self-denition and their purported evolutionary under- pinnings. A growing body of research has documented the neu- robiological circuits underlying relatedness (Bartz, Zaki, Bolger, & Ochsner, 2011; Gunnar & Quevedo, 2007; Insel & Young, 2001). These studies, based on both animal and human research, have implicated relatively distinct neural circuits in attachment and caregiving behaviors. These neu- ral circuits primarily involve a mesocorticolimbic dopami- nergic reward circuit and hypothalamic-midbrain-limbic- paralimbic-cortical circuits (Fonagy, Luyten, & Strathearn, 2011; Rutherford, Williams, Moy, Mayes, & Johns, 2011; Swain, Lorberbaum, Kose, & Strathearn, 2007). On the neurobiological level, the neuropeptides oxytocin and va- sopressin have been shown to play a key role in afliative behaviors ranging from parental care to pair bonding and sexual behavior (Insel & Young, 2001; Neumann, 2008). These neuropeptides are also involved in social cognition and social support (Feldman, Weller, Zagoory-Sharon, & Levine, 2007) as well as in regulating behavioral and neuroendocrinological responses to stress (Neumann, 2008). These ndings suggest that the ability to relate to others has an evolutionary advantage because of its close relationship with brain reward neurocircuitry, which rein- forces afliative behavior, resulting in broaden and build cycles (Fredrickson, 2001) that have been associated with high levels of relatedness and attachment security (Fonagy & Luyten, 2009; Mikulincer & Shaver, 2007). Indeed, effective stress regulation broadens ones awareness and encourages explorative behavior, broadening ones per- spective and building skills and resources (Fredrickson, 2001). Importantly, oxytocin also fosters positive feelings about the self, effective stress regulation, and explorative behavior (Insel & Young, 2001; Neumann, 2008), thus linking experiences of relatedness to opportunities to de- velop feelings of autonomy, competence, and identity, which in turn enhance coping and affect regulation (Fonagy & Luyten, 2009; Fredrickson, 2001; Mikulincer & Shaver, 2007). Hence, research in this area provides important neurobiological evidence for the view of two-polarities models that disruptions in the developmental dialectic in- teraction between relatedness and self-denition lead to disruptions in the development of these dimensions and in their underlying neural circuits (Simeon et al., 2011). Social and cognitive neuroscience has also delineated the neural circuits involved in the development of the self and self-representations. These mainly involve cortical midline structures, including the medial prefrontal cortex, posterior cingulate, precuneus, and temporal parietal junc- tion (Lieberman, 2007; Lombardo, Chakrabarti, Bullmore, & Baron-Cohen, 2011; Lombardo et al., 2010; for a meta- analysis, see Northoff et al., 2006), the same neural areas that have been shown to underlie social cognition with regard to others and theory of mind and mentalization in particular (DArgembeau et al., 2012; Fonagy & Luyten, 2009; Lieberman, 2007; Lombardo et al., 2010). Hence, congruent with the emphasis in two-polarities models on the synergistic interaction between relatedness and self- denition, studies in this area suggest overlap between 178 April 2013
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b r o a d l y . neural circuits involved in social cognition with regard to the self and others (Lombardo et al., 2010). From an evolutionary perspective, we may speculate that the emer- gence of the capacity to envision and reect upon the mental states (i.e., desires, feelings, values, and goals) of both self and others may have had an enormous advantage for survival by enabling the development of increasingly complex group and social structures (Allen, Fonagy, & Bateman, 2008). Recent research has also begun to explore the devel- opmental interaction of cultural and biological factors in this regard. Kim et al. (2010, 2011), for instance, found interactions among culture, stress, emotion regulation, and the G allele of the oxytocin receptor polymorphism rs53576 (which is implicated in the attachment system), providing support for the assumption of culturegene coevolution (Chiao & Blizinsky, 2010). For example, Kim and colleagues (2010) reported that distressed American participants with the oxytocin receptor GG/AG genotype sought more emotional social support, a culturally rein- forced and valued help-seeking pattern, compared with those with the AA genotype. In Korean participants, how- ever, within whose culture social support seeking is not a normative response under stress, social support seeking did not differ by genotype. A recent review found a robust cross-national correlation between the relative frequency of genes implicated in social sensitivity (e.g., 5-HTTLPR, MAOA-uVNTR, and OPRM1 A118G) and the degree of individualism versus collectivism (Way & Lieberman, 2010). Moreover, there was also a negative correlation between the frequency of these alleles and depression that was mediated by collectivism, suggesting that collectivism is related to reduced levels of depression in populations with a high proportion of social sensitivity alleles. While these ndings suggest that collectivism has developed in populations that are more sensitive to social inuences, and that these inuences buffer against depression, current changes in cultural patterns that disturb the balance be- tween relatedness and self-denition within a given culture, as discussed earlier, may have a dramatic impact on the prevalence of maladjustment and psychopathology. As many of these societies shift toward a greater emphasis on achievement and self-denition (individualism), with less emphasis on social ties and social support, it can be ex- pected that the prevalence of psychopathology will increase as the moderating inuence of social support and collec- tivistic attitudes more generally in these socially sensitive populations decreasesa grim prediction that is increas- ingly borne out by recent research ndings showing dra- matically increased rates of depression and suicide in these cultures (Im et al., 2011; Kwon et al., 2009; Ministerio de Salud, Gobierno de Chile, 2010; Organisation for Eco- nomic Co-Operation and Development, 2013). Conclusions The review presented in this article demonstrates that two- polarities models provide a comprehensive theoretical framework in which to investigate developmental continu- ities between normal and disrupted personality develop- ment, vulnerability for psychopathology, and responsive- ness to psychosocial interventions. Moreover, these models provide a theoretically informed basis for the exploration of interactions among biological, psychological, and social (environmental) factors in normal as well as disrupted personality development. Future research, rather than attempting to identify the universal causes of specic psychiatric disorders (Blatt & Luyten, 2009), should investigate how the interaction be- tween sociocultural and biological factors, including neural systems underlying the capacity for relatedness and self- denition, are implicated in the causation and treatment of spectra of disorders in different cultures (Cicchetti & Ro- gosch, 1996; Luyten, Vliegen, Van Houdenhove, & Blatt, 2008). Recent work, for instance, has explored the role of the neuropeptide oxytocin in the treatment of disorders that are marked by severe problems in relatedness, such as autism, schizophrenia, social phobia, and BPD (Striepens, Kendrick, Maier, & Hurlemann, 2011). Although based on very different assumptions, the Research Domain Criteria initiative of the National Institute of Mental Health has similarly proposed that future research should concentrate on different neurobiological systems that underlie basic psychological capacities (such as reward neurocircuity and neural systems implicated in self-representation, theory of mind, attachment/separation fear, and positive valence sys- tems) rather than on discrete disorders. As one author aptly remarked recently, it is highly unlikely that neurodevelop- mental genes have read the DSM (Eapen, 2012). More generally, more research on interactions between sociocul- tural factors and neural systems underlying the normal and disrupted development of relatedness and self-denition is needed. This proposed change in perspective will also require rather dramatic changes in the strategy of scientic journals and funding agencies. Current funding agencies and scien- tic journals are still mainly monodisciplinary in that despite notable attempts to foster interdisciplinary re- searchthey still focus on a single specic discipline (e.g., psychology, neuroscience, anthropology, etc.) and often on specic disorders. The views proposed in this article, how- ever, require by denition an interdisciplinary approach, with research focusing on the dynamics of both adaptive and disrupted personality development across the life span and on how disruptions in these dynamics may give rise to different disorders and problem behaviors, at different lev- els of analysis, from the molecular to the sociocultural level. Similarly, with regard to intervention and prevention, the views proposed in this article entail a shift from a largely disorder-centered focus to a more person-centered approach. Indeed, in the end, what is at stake is our under- standing of how biological predispositions in interaction with environmental inuences allow us to engage in what makes us quintessentially human: the development of the self and of interpersonal relationships. 179 April 2013
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b r o a d l y . REFERENCES Ahmad, I., & Soenens, B. (2010). Perceived maternal parenting as a mediator of the intergenerational similarity of dependency and self- criticism: A study with Arab Jordanian adolescents and their mothers. Journal of Family Psychology, 24(6), 756765. doi:10.1037/a0021508 Ainsworth, M., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the Strange Situation. New York, NY: Erlbaum. Allen, J. G., Fonagy, P., & Bateman, A. W. (2008). Mentalizing in clinical practice. Washington, DC: American Psychiatric Press. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Angyal, A. (1951). Neurosis and treatment: A holistic theory. New York, NY: Wiley. Bakan, D. (1966). The duality of human existence. Chicago, IL: Rand McNally. Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226244. doi:10.1037/0022-3514.61.2.226 Bartz, J. A., Zaki, J., Bolger, N., & Ochsner, K. N. (2011). Social effects of oxytocin in humans: Context and person matter. Trends in Cognitive Sciences, 15(7), 301309. Beauchaine, T. P., Klein, D. N., Crowell, S. E., Derbidge, C., & Gatzke- Kopp, L. (2009). Multinality in the development of personality dis- orders: A Biology Sex Environment interaction model of antiso- cial and borderline traits. Development and Psychopathology, 21(3), 735770. doi:10.1017/S0954579409000418 Beck, A. T. (1983). Cognitive therapy of depression: New perspectives. In P. J. Clayton & J. E. Barrett (Eds.), Treatment of depression: Old controversies and new approaches (pp. 265290). New York, NY: Raven Press. Beebe, B., Jaffe, J., Buck, K., Chen, H., Cohen, P., Blatt, S., . . . Andrews, H. (2007). Six-week postpartum maternal self-criticism and depen- dency and 4-month motherinfant self- and interactive contingencies. Developmental Psychology, 43, 13601376. doi:10.1037/0012-1649.43 .6.1360 Bender, D. S., Morey, L. C., & Skodol, A. E. (2011). Toward a model for assessing level of personality functioning in DSM-5, Part I: A review of theory and methods. Journal of Personality Assessment, 93(4), 332 346. doi:10.1080/00223891.2011.583808 Benjamin, L. S. (2005). Interpersonal theory of personality disorders. The structural analysis of social behaviour and interpersonal reconstructive therapy. In M. F. Lenzenweger & J. F. Clarkin (Eds.), Major theories of personality disorder (2nd ed., pp. 157230). New York, NY: Guil- ford Press. Besser, A., Luyten, P., Vliegen, N., & Blatt, S. J. (2008). A psychody- namic perspective on depression. In W. Hansson & E. Olsson (Eds.), New perspectives on women and depression (pp. 1562). New York, NY: Nova Science Press. Besser, A., & Priel, B. (2005). The apple does not fall far from the tree: Attachment styles and personality vulnerabilities to depression in three generations of women. Personality and Social Psychology Bulletin, 31(8), 10521073. doi:10.1177/0146167204274082 Besser, A., Vliegen, N., Luyten, P., & Blatt, S. J. (2008). Systematic empirical investigation of vulnerability to postpartum depression from a psychodynamic perspective: Commentary on issues raised by Blum (2007). Psychoanalytic Psychology, 25(2), 392410. doi:10.1037/ 0736-9735.25.2.392 Blatt, S. J. (1974). Levels of object representation in anaclitic and intro- jective depression. Psychoanalytic Study of the Child, 29, 107157. Blatt, S. J. (2008). Polarities of experience: Relatedness and self-deni- tion in personality development, psychopathology, and the therapeutic process. Washington, DC: American Psychological Association. doi: 10.1037/11749-000 Blatt, S. J., & Homann, E. (1992). Parentchild interaction in the etiology of dependent and self-critical depression. Clinical Psychology Review, 12, 4791. doi:10.1016/0272-7358(92)90091-L Blatt, S. J., & Luyten, P. (2009). A structural-developmental psychody- namic approach to psychopathology: Two polarities of experience across the life span. Development and Psychopathology, 21(3), 793 814. doi:10.1017/S0954579409000431 Blatt, S. J., & Luyten, P. (2010). Reactivating the psychodynamic ap- proach to classify psychopathology. In T. Millon, R. F. Krueger & E. Simonsen (Eds.), Contemporary directions in psychopathology. Scien- tic foundations of the DSM-V and ICD-11 (pp. 483514). New York, NY: Guilford Press. Blatt, S. J., & Shichman, S. (1983). Two primary congurations of psychopathology. Psychoanalysis & Contemporary Thought, 6, 187 254. Blatt, S. J., Zuroff, D. C., Hawley, L. L., & Auerbach, J. S. (2010). Predictors of sustained therapeutic change. Psychotherapy Research, 20, 3754. doi:10.1080/10503300903121080 Bornstein, R. F. (1992). The dependent personality: Developmental, so- cial, and clinical perspectives. Psychological Bulletin, 112, 323. doi: 10.1037/0033-2909.112.1.3 Bornstein, R. F., & Languirand, M. A. (2003). Healthy dependency. New York, NY: Newmarket Press. Cassidy, J., & Shaver, P. R. (Eds.). (2008). Handbook of attachment: Theory, research, and clinical applications. New York, NY: Guilford Press. Chang, E. C., & Asakawa, K. (2003). Cultural variations on optimistic and pessimistic bias for self versus a sibling: Is there evidence for self- enhancement in the West and for self-criticism in the East when the referent group is specied? Journal of Personality and Social Psychol- ogy, 84(3), 569581. doi:10.1037/0022-3514.84.3.569 Chiao, J. Y., & Blizinsky, K. D. (2010). Culturegene coevolution of individualism-collectivism and the serotonin transporter gene. Proceed- ings of the Royal Society B: Biological Sciences, 277(1681), 529537. Cicchetti, D., & Rogosch, F. A. (1996). Equinality and multinality in developmental psychopathology. Development and Psychopathology, 8, 597600. doi:10.1017/S0954579400007318 Clark, D. A., & Beck, A. T. (1999). Scientic foundations of cognitive theory and therapy of depression. New York, NY: Wiley. Cohen, A. B., & Hill, P. C. (2007). Religion as culture: Religious indi- vidualism and collectivism among American Catholics, Jews, and Prot- estants. Journal of Personality, 75, 709742. doi:10.1111/j.1467-6494 .2007.00454.x DArgembeau, A., Jedidi, H., Balteau, E., Bahri, M., Phillips, C., & Salmon, E. (2012). Valuing ones self: Medial prefrontal involvement in epistemic and emotive investments in self-views. Cerebral Cortex, 22(3), 659667. doi:10.1093/cercor/bhr144 Deci, E. L., & Ryan, R. M. (2012). Self-determination theory. In P. A. M. V. Lange, A. W. Kruglanski & E. T. Higgins (Eds.), Handbook of theories of social psychology (Vol. 1, pp. 416437). Thousand Oaks, CA: Sage. DiBartolo, P. M., & Rendn, M. J. (2012). A critical examination of the construct of perfectionism and its relationship to mental health in Asian and African Americans using a cross-cultural framework. Clinical Psychology Review, 32(3), 139152. doi:10.1016/j.cpr.2011.09.007 Eapen, V. (2012). Neurodevelopmental genes have not read the DSM criteria: Or, have they? Frontiers in Psychiatry, 3, Article 75. doi: 10.3389/fpsyt.2012.00075 Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31(2), 203212. doi:10.1016/j.cpr.2010.04.009 Feldman, R., Weller, A., Zagoory-Sharon, O., & Levine, A. (2007). Evidence for a neuroendocrinological foundation of human afliation: Plasma oxytocin levels across pregnancy and the postpartum period predict motherinfant bonding. Psychological Science, 18(11), 965 970. doi:10.1111/j.1467-9280.2007.02010.x Fonagy, P., & Luyten, P. (2009). A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Development and Psychopathology, 21(4), 13551381. doi: 10.1017/S0954579409990198 Fonagy, P., Luyten, P., & Strathearn, L. (2011). Borderline personality disorder, mentalization, and the neurobiology of attachment. Infant Mental Health Journal, 32(1), 4769. doi:10.1002/imhj.20283 Fraley, R. C., & Roberts, B. W. (2005). Patterns of continuity: A dynamic model for conceptualizing the stability of individual differences in psychological constructs across the life course. Psychological Review, 112, 6074. doi:10.1037/0033-295X.112.1.60 180 April 2013
American Psychologist T h i s
d o c u m e n t
i s
c o p y r i g h t e d
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A s s o c i a t i o n
o r
o n e
o f
i t s
a l l i e d
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a n d
i s
n o t
t o
b e
d i s s e m i n a t e d
b r o a d l y . Fredrickson, B. L. (2001). The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Amer- ican Psychologist, 56(3), 218226. doi:10.1037/0003-066X.56.3.218 Freud, S. (1930). Civilization and its discontents. In J. Strachey (Ed.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 21, pp. 57146). London, England: Hogarth Press. George, C., Kaplan, N., & Main, M. (1985). The Adult Attachment Interview. Unpublished manuscript, Department of Psychology, Uni- versity of California, Berkeley. Gluckman, P. D., Hanson, M. A., Bateson, P., Beedle, A. S., Law, C. M., Bhutta, Z. A., . . . West-Eberhard, M. J. (2009). Towards a new developmental synthesis: Adaptive developmental plasticity and human disease. Lancet, 373(9675), 1654 1657. doi:10.1016/S0140- 6736(09)60234-8 Grossmann, K., Grossmann, K. E., Spangler, G., Suess, G., & Unzner, L. (1985). Maternal sensitivity and newborns orientation responses as related to quality of attachment in northern Germany. Monographs of the Society for Research in Child Development, 50(1/2), 233256. doi:10.2307/3333836 Gunnar, M., & Quevedo, K. (2007). The neurobiology of stress and development. Annual Review of Psychology, 58(1), 145173. doi: 10.1146/annurev.psych.58.110405.085605 Gunnar, M. R., Quevedo, K., De Kloet, R. E., Oitzl, M. S., & Eric, V. (2008). Early care experiences and HPA axis regulation in children: A mechanism for later trauma vulnerability. Progress in Brain Research, 167, 137149. doi:10.1016/S0079-6123(07)67010-1 Herman, K. C., Trotter, R., Reinke, W. M., & Ialongo, N. (2011). Developmental origins of perfectionism among African American youth. Journal of Counseling Psychology, 58(3), 321334. doi:10.1037/ a0023108 Horowitz, L. M., & Strack, S. (Eds.). (2011). Handbook of interpersonal psychology: Theory, research, assessment. New York, NY: Wiley. Horowitz, L. M., Wilson, K. R., Turan, B., Zolotsev, P., Constantino, M. J., & Henderson, L. (2006). How interpersonal motives clarify the meaning of interpersonal behavior: A revised circumplex model. Per- sonality and Social Psychology Review, 10(1), 6786. doi:10.1207/ s15327957pspr1001_4 Im, J.-S., Choi, S. H., Hong, D., Seo, H. J., Park, S., & Hong, J. P. (2011). Proximal risk factors and suicide methods among suicide completers from national suicide mortality data 20042006 in Korea. Comprehen- sive Psychiatry, 52(3), 231237. doi:10.1016/j.comppsych.2010.07.005 Insel, T. R., & Young, L. J. (2001). The neurobiology of attachment. Nature Reviews Neuroscience, 2, 129136. doi:10.1038/35053579 Kagitcibasi, C. (2005). Autonomy and relatedness in cultural context: Implications for self and family. Journal of Cross-Cultural Psychology, 36, 403422. doi:10.1177/0022022105275959 Kazdin, A. E. (2011). Evidence-based treatment research: Advances, limitations, and next steps. American Psychologist, 66(8), 685698. doi:10.1037/a0024975 Kernberg, O. F., & Caligor, E. (2005). A psychoanalytic theory of per- sonality disorders. In M. F. Lenzenweger & J. F. Clarkin (Eds.), Major theories of personality disorder (2nd ed., pp. 114156). New York, NY: Guilford Press. Kiesler, D. J. (1983). The 1982 interpersonal circle: A taxonomy for complementarity in human transactions. Psychological Review, 90, 185214. doi:10.1037/0033-295X.90.3.185 Kim, H. S., Sherman, D. K., Mojaverian, T., Sasaki, J. Y., Park, J., Suh, E. M., & Taylor, S. E. (2011). Geneculture interaction: Oxytocin receptor polymorphism (OXTR) and emotion regulation. Social Psy- chological and Personality Science, 2(6), 665672. doi:10.1177/ 1948550611405854 Kim, H. S., Sherman, D. K., Sasaki, J. Y., Xu, J., Chu, T. Q., Ryu, C., . . . Taylor, S. E. (2010). Culture, distress, and oxytocin receptor polymorphism (OXTR) interact to inuence emotional support seeking. PNAS: Proceedings of the National Academy of Sciences of the United States of America, 107(36), 1571715721. doi:10.1073/pnas .1010830107 Kitayama, S., Markus, H. R., Matsumoto, H., & Norasakkunkit, V. (1997). Individual and collective processes in the construction of the self: Self-enhancement in the United States and self-criticism in Japan. Journal of Personality and Social Psychology, 72(6), 12451267. doi: 10.1037/0022-3514.72.6.1245 Krueger, R. F., Skodol, A. E., Livesley, W. J., Shrout, P. E., & Huang, Y. (2007). Synthesizing dimensional and categorical approaches to per- sonality disorders: Rening the research agenda for DSM-V Axis II. International Journal of Methods in Psychiatric Research, 16(Suppl. 1), S65S73. doi:10.1002/mpr.212 Kwon, J.-W., Chun, H., & Cho, S. (2009). A closer look at the increase in suicide rates in South Korea from 19862005. BMC Public Health, 9, Article 72. doi: 10.1186/1471-2458-9-72 Lahey, B. B., Rathouz, P. J., Van Hulle, C., Urbano, R. C., Krueger, R. F., Applegate, B., . . . Waldman, I. D. (2008). Testing structural models of DSM-IV symptoms of common forms of child and adolescent psycho- pathology. Journal of Abnormal Child Psychology, 36(2), 187206. doi:10.1007/s10802-007-9169-5 Leadbeater, B. J., Kuperminc, G. P., Blatt, S. J., & Hertzog, C. (1999). A multivariate mode of gender differences in adolescents internalizing and externalizing problems. Developmental Psychology, 35(5), 1268 1282. doi:10.1037/0012-1649.35.5.1268 Leary, T. (1957). The interpersonal diagnosis of personality. New York, NY: Ronald Press. Levy, K. N., Edell, W. S., & McGlashan, T. H. (2007). Depressive experiences in inpatients with borderline personality disorder. Psychi- atric Quarterly, 78(2), 129143. doi:10.1007/s11126-006-9033-8 Lieberman, M. D. (2007). Social cognitive neuroscience: A review of core processes. Annual Review of Psychology, 58, 259289. doi:10.1146/ annurev.psych.58.110405.085654 Livesley, J. (2008). Toward a genetically-informed model of borderline personality disorder. Journal of Personality Disorders, 22(1), 4271. doi:10.1521/pedi.2008.22.1.42 Locke, D. (2010). Circumplex measures of interpersonal constructs. In L. M. Horowitz & S. Strack (Eds.), Handbook of interpersonal psy- chology: Theory, research, assessment, and therapeutic intervention (pp. 313324). Hoboken, NJ: Wiley. doi:10.1002/9781118001868.ch19 Lombardo, M. V., Chakrabarti, B., Bullmore, E. T., & Baron-Cohen, S. (2011). Specialization of right temporo-parietal junction for mentaliz- ing and its relation to social impairments in autism. NeuroImage, 56(3), 18321838. doi:10.1016/j.neuroimage.2011.02.067 Lombardo, M. V., Chakrabarti, B., Bullmore, E. T., Wheelwright, S. J., Sadek, S. A., Suckling, J., . . . Baron-Cohen, S. (2010). Shared neural circuits for mentalizing about the self and others. Journal of Cognitive Neuroscience, 22(7), 16231635. doi:10.1162/jocn.2009.21287 Lowyck, B., Luyten, P., Verhaest, Y., Vandeneede, B., & Vermote, R. (in press). Levels of personality functioning and their association with clinical features and interpersonal functioning in patients with person- ality disorders (PDs). Journal of Personality Disorders. Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nature Reviews Neuroscience, 10(6), 434445. doi:10.1038/nrn2639 Luyten, P., & Blatt, S. J. (2007). Looking back towards the future: Is it time to change the DSM approach to psychiatric disorders? The case of depression. Psychiatry: Interpersonal and Biological Processes, 70(2), 8599. doi:10.1521/psyc.2007.70.2.85 Luyten, P., & Blatt, S. J. (2011). Integrating theory-driven and empirical- ly-derived models of personality development and psychopathology: A proposal for DSM-V. Clinical Psychology Review, 31, 5268. doi: 10.1016/j.cpr.2010.09.003 Luyten, P., Blatt, S. J., & Mayes, L. C. (2012). Process and outcome in psychoanalytic psychotherapy research: The need for a (relatively) new paradigm. In R. A. Levy & J. S. Ablon & H. Kchele (Eds.), Psychody- namic psychotherapy research: Evidence-based practice and practice- based evidence (pp. 345359). New York, NY: Humana Press/ Springer. doi:10.1007/978-1-60761-792-1_21 Luyten, P., Corveleyn, J., & Blatt, S. J. (2005). The convergence among psychodynamic and cognitive-behavioral theories of depression: A critical overview of empirical research. In J. Corveleyn, P. Luyten, & S. J. Blatt (Eds.), The theory and treatment of depression: Towards a dynamic interactionism model (pp. 107147). Mahwah, NJ: Erlbaum. Luyten, P., Kempke, S., Van Wambeke, P., Claes, S. J., Blatt, S. J., & Van Houdenhove, B. (2011). Self-critical perfectionism, stress generation and stress sensitivity in patients with chronic fatigue syndrome: Rela- tionship with severity of depression. Psychiatry: Interpersonal and Biological Processes, 74(1), 2130. doi:10.1521/psyc.2011.74.1.21 Luyten, P., Mayes, L. C., Target, M., & Fonagy, P. (2012). Developmental 181 April 2013
American Psychologist T h i s
d o c u m e n t
i s
c o p y r i g h t e d
b y
t h e
A m e r i c a n
P s y c h o l o g i c a l
A s s o c i a t i o n
o r
o n e
o f
i t s
a l l i e d
p u b l i s h e r s . T h i s
a r t i c l e
i s
i n t e n d e d
s o l e l y
f o r
t h e
p e r s o n a l
u s e
o f
t h e
i n d i v i d u a l
u s e r
a n d
i s
n o t
t o
b e
d i s s e m i n a t e d
b r o a d l y . research. In G. O. Gabbard, B. Litowitz, & P. Williams (Eds.), Textbook of psychoanalysis (2nd ed., pp. 423442). Washington, DC: American Psychiatric Press. Luyten, P., Sabbe, B., Blatt, S. J., Meganck, S., Jansen, B., De Grave, C., . . . Corveleyn, J. (2007). Dependency and self-criticism: Relationship with major depressive disorder, severity of depression, and clinical presentation. Depression and Anxiety, 24(8), 586596. doi:10.1002/da .20272 Luyten, P., Vliegen, N., Van Houdenhove, B., & Blatt, S. J. (2008). Equinality, multinality, and the rediscovery of the importance of early experiences: Pathways from early adversity to psychiatric and (functional) somatic disorders. Psychoanalytic Study of the Child, 63, 2760. Markus, H. R., & Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion and motivation. Psychological Review, 98(2), 224253. doi:10.1037/0033-295X.98.2.224 Matsumoto, D., & Van de Vijver, F. (2011). Cross-cultural research methods in psychology. New York, NY: Cambridge University Press. McAdams, D. P. (1985). Power, intimacy, and the life story: Persono- logical inquiries into identity. Homewood, IL: Dorsey. McClelland, D. C. (1985). Human motivation. Cambridge, England: Cam- bridge University Press. McHugh, R. K., Murray, H. W., & Barlow, D. H. (2009). Balancing delity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions. Behaviour Research and Therapy, 47(11), 946953. doi:10.1016/j.brat.2009.07 .005 Meyer, B., & Pilkonis, P. A. (2005). An attachment model of personality disorder. In M. F. Lenzenweger & J. F. Clarkin (Eds.), Major theories of personality disorder (pp. 231281). New York, NY: Guilford Press. Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Struc- ture, dynamics and change. New York, NY: Guilford Press. Ministerio de Salud, Gobierno de Chile. (2010). Mortalidad por causas, segn sexo. Chile 20002009 [Mortality causes and gender. Chile 20002009]. Retrieved from http://deis.minsal.cl/vitales/Mortalidad _causa/Chile.htm Munir, K. M., & Beardslee, W. R. (1999). Developmental psychiatry: Is there any other kind? Harvard Review of Psychiatry, 6, 250262. doi:10.3109/10673229909000337 Neumann, I. D. (2008). Brain oxytocin: A key regulator of emotional and social behaviours in both females and males. Journal of Neuroendo- crinology, 20(6), 858865. doi:10.1111/j.1365-2826.2008.01726.x Northoff, G., Heinzel, A., de Greck, M., Bermpohl, F., Dobrowolny, H., & Panksepp, J. (2006). Self-referential processing in our brainA meta-analysis of imaging studies on the self. NeuroImage, 31(1), 440 457. doi:10.1016/j.neuroimage.2005.12.002 Organisation for Economic Co-Operation and Development. (2013). OECD factbook 2013: Economic, environmental and social statistics. Paris, France: OECD Publishing. Otani, K., Suzuki, A., Kamata, M., Matsumoto, Y., Shibuya, N., Sadahiro, R., & Enokido, M. (2012). Parental overprotection increases sociotropy with gender specicity in parents and recipients. Journal of Affective Disorders, 136, 824827. doi:10.1016/j.jad.2011.09.033 Ouimette, P. C., & Klein, D. N. (1993). Convergence of psychoanalytic and cognitive-behavioral theories of depression: An empirical review and new data on Blatts and Becks models. In J. M. Masling & R. F. Bornstein (Eds.), Empirical studies of psychoanalytic theories (Vol. 4, pp. 191223). Washington, DC: American Psychological Association. Parker, G., Roy, K., Wilhelm, K., Mitchell, P., Austin, M.-P., & Hadzi- Pavlovic, D. (1999). Sub-grouping non-melancholic major depression using both clinical and aetiological features. Australian and New Zea- land Journal of Psychiatry, 33, 217225. doi:10.1046/j.1440-1614 .1999.00545.x Pincus, A. L. (2005). A contemporary integrative interpersonal theory of personality disorders. In M. F. Lenzenweger & J. F. Clarkin (Eds.), Major theories of personality disorder (2nd ed., pp. 282331). New York, NY: Guilford Press. Roisman, G. I., Holland, A., Fortuna, K., Fraley, R. C., Clausell, E., & Clarke, A. (2007). The Adult Attachment Interview and self-reports of attachment style: An empirical rapprochement. Journal of Personality and Social Psychology, 92(4), 678697. doi:10.1037/0022-3514.92.4 .678 Rutherford, H. J., Williams, S. K., Moy, S., Mayes, L. C., & Johns, J. M. (2011). Disruption of maternal parenting circuitry by addictive process: Rewiring of reward and stress systems. Frontiers in Child and Neuro- developmental Psychiatry, 2, Article 37. doi: 10.3389/fpsyt.2011.00037 Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 6878. doi:10.1037/0003-066X.55.1.68 Ryan, R. M., & Deci, E. L. (2006). Self-regulation and the problem of human autonomy: Does psychology need choice, self-determination, and will? Journal of Personality, 74(6), 15571585. doi:10.1111/j .1467-6494.2006.00420.x Safran, J. D., Muran, J. C., & Eubanks-Carter, C. (2011). Repairing alliance ruptures. Psychotherapy (Chicago, Ill.), 48(1), 8087. doi: 10.1037/a0022140 Safran, J. D., Muran, J. C., Samstag, L. W., & Steven, C. (2002). Repairing alliance ruptures. In J. C. Norcross (Ed.), Psychotherapy relationships that work (pp. 235254). Oxford, England: Oxford Uni- versity Press. Sbarra, D. A., & Hazan, C. (2008). Coregulation, dysregulation, self- regulation: An integrative analysis and empirical agenda for under- standing adult attachment, separation, loss, and recovery. Personality and Social Psychology Review, 12(2), 141167. doi:10.1177/ 1088868308315702 Shahar, G., Henrich, C. C., Blatt, S. J., Ryan, R., & Little, T. D. (2003). Interpersonal relatedness, self-denition, and their motivational orien- tation during adolescence: A theoretical and empirical integration. Developmental Psychology, 39, 470483. doi:10.1037/0012-1649.39.3 .470 Shahar, G., Kalnitzki, E., Shulman, S., & Blatt, S. J. (2006). Personality, motivation, and the construction of goals during the transition to adult- hood. Personality and Individual Differences, 40(1), 5363. doi: 10.1016/j.paid.2005.06.016 Sibley, C. (2007). The association between working models of attachment and personality: Toward an integrative framework operationalizing global relational models. Journal of Research in Personality, 41(1), 90109. doi:10.1016/j.jrp.2006.03.002 Sibley, C., & Overall, N. (2007). The boundaries between attachment and personality: Associations across three levels of the attachment network. Journal of Research in Personality, 41(4), 960967. doi:10.1016/j.jrp .2006.10.002 Sibley, C., & Overall, N. (2008). The boundaries between attachment and personality: Localized versus generalized effects in daily social inter- action. Journal of Research in Personality, 42(6), 13941407. doi: 10.1016/j.jrp.2008.06.004 Sibley, C., & Overall, N. (2010). Modeling the hierarchical structure of personality-attachment associations: Domain diffusion versus domain differentiation. Journal of Social and Personal Relationships, 27(1), 4770. doi:10.1177/0265407509346421 Silverstein, B. (2002). Gender differences in the prevalence of somatic versus pure depression: A replication. American Journal of Psychiatry, 159, 10511052. doi:10.1176/appi.ajp.159.6.1051 Silverstein, B., Clauson, J., Perdue, L., Carpman, S., & Cimarolli, V. (1998). The association between female college students reports of depression and their perceptions of parental attitudes regarding gender. Journal of Applied Social Psychology, 28, 537549. doi:10.1111/j .1559-1816.1998.tb01718.x Simeon, D., Bartz, J., Hamilton, H., Crystal, S., Braun, A., Ketay, S., & Hollander, E. (2011). Oxytocin administration attenuates stress reactiv- ity in borderline personality disorder: A pilot study. Psychoneuroendo- crinology, 36, 14181421. doi:10.1016/j.psyneuen.2011.03.013 Skodol, A. A. (2011). Scientic issues in the revision of personality disorders for DSM-5. Personality and Mental Health, 5, 97111. doi: 10.1002/pmh.161 Skodol, A. E. (2012). Personality disorders in DSM-5. Annual Review of Clinical Psychology, 8(1), 317344. doi:10.1146/annurev-clinpsy- 032511-143131 Skodol, A. E., & Bender, D. S. (2009). The future of personality disorders in DSM-V? American Journal of Psychiatry, 166(4), 388391. doi: 10.1176/appi.ajp.2009.09010090 Skodol, A. E., Bender, D. S., Morley, L. C., Clark, L. A., Oldham, J. M., Alarcon, R. D., . . . Siever, L. J. (2011). Personality disorder types 182 April 2013
American Psychologist T h i s
d o c u m e n t
i s
c o p y r i g h t e d
b y
t h e
A m e r i c a n
P s y c h o l o g i c a l
A s s o c i a t i o n
o r
o n e
o f
i t s
a l l i e d
p u b l i s h e r s . T h i s
a r t i c l e
i s
i n t e n d e d
s o l e l y
f o r
t h e
p e r s o n a l
u s e
o f
t h e
i n d i v i d u a l
u s e r
a n d
i s
n o t
t o
b e
d i s s e m i n a t e d
b r o a d l y . proposed for DSM-5. Journal of Personality Disorders, 25, 136169. doi:10.1521/pedi.2011.25.2.136 Soenens, B., Elliot, A. J., Goossens, L., Vansteenkiste, M., Luyten, P., & Duriez, B. (2005). The intergenerational transmission of perfectionism: Parents psychological control as an intervening variable. Journal of Family Psychology, 19(3), 358366. doi:10.1037/0893-3200.19.3.358 Soenens, B., Park, S.-Y., Vansteenkiste, M., & Mouratidis, A. (2012). Perceived parental psychological control and adolescent depressive experiences: A cross-cultural study with Belgian and South-Korean adolescents. Journal of Adolescence, 35, 261272. doi:10.1016/j .adolescence.2011.05.001. Soenens, B., Vansteenkiste, M., & Luyten, P. (2010). Towards a domain- specic approach to the study of parental psychological control: Dis- tinguishing between dependency-oriented and achievement-oriented psychological control. Journal of Personality, 78(1), 217256. doi: 10.1111/j.1467-6494.2009.00614.x Sroufe, L. A. (1997). Psychopathology as an outcome of development. Development and Psychopathology, 9, 251268. doi:10.1017/ S0954579497002046 Sroufe, L. A., Carlson, E. A., Levy, A. K., & Egeland, B. (1999). Implications of attachment theory for developmental psychopathology. Development and Psychopathology, 11, 113. doi:10.1017/ S0954579499001923 Striepens, N., Kendrick, K. M., Maier, W., & Hurlemann, R. (2011). Prosocial effects of oxytocin and clinical evidence for its therapeutic potential. Frontiers in Neuroendocrinology, 32, 426450. doi:10.1016/ j.yfrne.2011.07.001 Swain, J. E., Lorberbaum, J. P., Kose, S., & Strathearn, L. (2007). Brain basis of early parentinfant interactions: Psychology, physiology, and in vivo functional neuroimaging studies. Journal of Child Psychology and Psychiatry, 48(34), 262287. doi:10.1111/j.1469-7610.2007 .01731.x Triandis, H. C. (2001). Individualismcollectivism and personality. Jour- nal of Personality, 69(6), 907924. doi:10.1111/1467-6494.696169 van IJzendoorn, M. H., & Sagi-Schwartz, A. (2008). Cross-cultural pat- terns of attachment: Universal and contextual dimensions. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 880905). New York, NY: Guilford Press. Way, B. M., & Lieberman, M. D. (2010). Is there a genetic contribution to cultural differences? Collectivism, individualism and genetic mark- ers of social sensitivity. Social Cognitive and Affective Neuroscience, 5(23), 203211. doi:10.1093/scan/nsq059 Wiggins, J. S. (1991). Agency and communion as conceptual coordinates for the understanding and measurement of interpersonal behavior. In W. W. Grove & D. Cicchetti (Eds.), Thinking clearly about psychology (Vol. 2, pp. 89113). Minneapolis, MN: University of Minnesota Press. Wiggins, J. S. (Ed.). (2003). Paradigms of personality assessment. New York, NY: Guilford Press. Zuroff, D. C., Koestner, R., Moskowitz, D. S., McBride, C., & Bagby, R. M. (2012). Therapists autonomy support and patients self-criticism predict motivation during brief treatments for depression. Journal of Social & Clinical Psychology, 31, 903932. doi:10.1521/jscp.2012.31 .9.903. Zuroff, D. C., Mongrain, M., & Santor, D. A. (2004). Conceptualizing and measuring personality vulnerability to depression: Commentary on Coyne and Whiffen (1995). Psychological Bulletin, 130, 453472. doi:10.1037/0033-2909.130.3.489 183 April 2013